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� � � <br /> / <br />� � <br /> City of Orono <br /> Building Permit Application � �g� ,�9 <br /> �, for New Structures or Additions � <br /> 'i '' �,� .; Mailing Address: �. <br /> � l ����' ����� PO Box 66 Permit number: �5— � �j ; <br /> � �� ^� �✓ �,_� Crystal Bay, MN 55323-0066 Date received: � <br /> ���` ' � � Street Address:' � �1 <br /> " � 2750 Kelle Parkwa � �5 ..� <br /> .� lq � �, . ` <br /> ti� G� , , i y y 2���-ooR�� Plan review fee: . <br /> � , <br /> Orono, MN 55356 <br /> Kfsr►o� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 �✓��ww.ci_orono.mn.us `F� � <br /> This application form must be completed in full and all required information must� e submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��' <br /> 1 U � i�+v rr-� Ln ���, <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 w�ll be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATtON: <br /> Name: G- � ►� �-��� }{o v�� S <br /> State License# � .5�� Expiration Date: <br /> Phone: cell � - t�4- office <br /> Mailing Address: (c � G � o�. M r�� i�,r Cit : �:, r� U IP: 5 S 'a � <br /> Contact Person: Ft v� Applicant is: ractor / Home wner (Circle One) <br /> Email and/or Fax: �2t-1���i.� c.�c�c�4 �Pa���^c S � C r���'K <br /> PROPERTY OWNER INFORMATION: 1� <br /> Name: �-o nV�'�i C���S <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �'� �"�''l ����`�f <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ew Construction ingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Of�ise/Commercial � <br /> ❑ Relocation detached garage [�esidence Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater �ic Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse Private 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 /> www.rninnehahacreek.or <br /> Estimated Construction Valuat;on (excluding land) $ J`-(>�f ��% CJ' <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />