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. , <br /> C�ty of ��-ono <br /> ��ilc�i�� Per�it i4pplication 7���� <br /> for �ev� Sfruc��res or �4dditions <br /> Mailing Address: <br /> QAT PO Box 66 Permit number. d� 7�Z'J � <br /> � �V� . Crystal Bay, MN 55323-0066 Date received: � — �j/ <br /> � �,`� StreefAddress:' Received by: y � <br /> � ,� If� 2750 Kelley Parkway <br /> y�, (/" � Plan review fee: <br /> �` Orono, MN 55356 <br /> �'�kFsxo��' �' Main: 952-249-4600 Total Fee: �5�� <br /> Fax: 952-249-4616 w�vw.ci.orono.mn.us kf �(�j — <br /> This application form must be completed in full and all required informa�ior� must be submitted. O�� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � L� � , ` ��v-k � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Home? ❑ Yes o <br /> lf yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-pe�mitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAT ON: <br /> Name: G� ,�y ,er� �1� ,,,,�,��, <br /> State License # _ �yS�� Expiration Date: <br /> Phone: (cell) (�l'� -� �ti - q� `� (office) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: �f 1.��„� Applicant is: actor Homeowner (Circle One) <br /> Email and/or Fax: �j- �r� q o,,��,�,�1.�vw�� < , c c vt� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <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 /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: Z�p• <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 /> ❑ New Construction Sin le Famil with �Nater Supply <br /> � g y ❑Accessory Bldg./Garage <br /> �Addition attached ara e 'Deck <br /> Accesso Buildin 9 9 � ❑ Public Sewer <br /> rY 9 ❑ Single Family with ❑ Office/Commercisl <br /> ❑ Relocation detached garage ❑ Residence �eptic <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certifcate <br /> ❑ Public 4-feet or greater may be required) <br /> '"`Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 �rivate Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.or4 <br /> Estimated Construction Valuation (excluding land) $ l S �Q�� `�� <br /> Packet Last Updated.� January 2016 T <br /> Page 21 <br />