Laserfiche WebLink
. <br />" ° City of Orono � <br /> Building Permit Application �� - <br /> � � � <br /> for New Structures or Additions � <br /> Mailing Address: J � <br /> �Q A,O PO Box 66 Permit number: - G%j�/�.��^ <br /> �w Crystal Bay, MN 55323-0066 Date received: .�-�� <br /> Street Address:' Received by: / '-��f� <br /> � ,Z- 2750 Kelley Parkway a � <br /> tiF Plan review fee: <br /> c,` Orono, MN 55356 ��- <br /> tqkfSHO�� Main: 952-249-4600 Total Fee: `� ���5 G/ <br /> Fax: 952-249-4616 www.ci.orono.rlin.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��5 �tk�v��� l��r� w ay <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 un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: Gon �ea � fl��' <br /> State License# S "� Expiration Date: <br /> Phone: cell (�[ —�N�—`�t�(o office <br /> Mailing Address: /U Q 5 ov� ►�'l e,,v, w Cit : C7'a cvt Q e I P: .5 S 2 � <br /> Contact Person: hu.v� Applicant is: / Homeowner (CircleOne) <br /> Email and/or Fax: ���vt�n pqpv���.eAhow►e5- C o v✓i <br /> PROPERTY OWNER INFORMATION: <br /> Name: �j C� ht�i,� �-f-o �^'�F S <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �"��yea �c�w�-� S <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 /> �AJew 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 nvate Sewer <br /> ❑ Other: (specify) ❑ Multiple Family 1 Condo etaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��S C��D!�� <br /> RECEIVED <br /> Packet Last Updated: August 2015 page 21 SEf' 2 3 2015 <br />