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� ' City of Orono <br /> . <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: D����/� <br /> 0A, PO Box 66 Permit number: <br /> � `VQ Crystal Bay, MN 55323-0066 Date received: ��D� ^ <br /> Street Address:' eived � <br /> 2750 Kelley Parkway <br /> y�, � Plan review fee: �J'��. � <br /> c,` Orono, MN 55356 � a !�-��j � � <br /> `�'�ESHO�� Main: 952-249-4600 otal Fee: 5 <br /> Fax: 952-249-4616 ww�ti.c,.oron�.mn.us ` '� � <br /> ' , J ��1 <br /> This application form must be completed in full and all required information must be submitted. � <br /> Incomplete applications will be returned. (P/ease print)����-4y,'�; iS-� S/ �� <br /> GENERAL INFORMATION: ,�}. G1�1��Q,h�-�`� <br /> Job Site Address: �C.�L� kc����� �-c���� �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL�,CANT INFORM�ION: <br /> Name: (�-t� h �t,� �r_ <br /> State License# � S Expiration Date: <br /> Phone: cell j'�._-'7 (- ��, office <br /> MUiling Address: �[�"a-- Q o h cvv� b�w�v Cit : (.,� �� G �'� IP: <br /> Contact Person: l�v� Applicant is: ractor Home wner (Circle One) <br /> Email and/or Fax: e, L�av���c�►�•�.��h��„�es. Cowt <br /> PROPERTY OWNER INFORMATION: <br /> Name: �ryv y1v�� �TtC��� � <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ew Construction Single Family with ❑ Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> v,ww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �dc� pa� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />