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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �('��—(�// <br /> � �Q PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: � —�.S <br /> Street Address:' Received <br /> � � 2750 Kelley Parkway ��>5 � <br /> y�' c,` Orono, MN 55356 � ' Plan review fee: <br /> `qkESHO�� Main: 952-249-4600 Total Fee: /��g� <br /> Fax: 952-249-4616 �vv,.n.ci.orono.mn.us <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) �/C�Q , 3 � <br /> GENERAL INFORMATION: , ���� ���� <br /> _ __ <br /> Job Site Address: /�'�fC" �-�;/�G-����-a-- j r.r<:� �= �� <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 INFORMATION: <br /> Name: � c�- >>4�-��:/ ����-��., � .r'�j-,-,��l=./,�,� .�� �, <br /> State License# ,G'� " ,� ?��Z Expiration Date: �-�/�/ / " <br /> Phone: (cell) /Z— Z Z/- S�"��� (office) �/Z - Z Z�- S-`i%i y <br /> Mailing Address: 7Ei�%c> ��r-.�.�/4�, L� ti Cit � /� l�Z-�-� ZIP: �S.�// <br /> Contact Person: l/,-�� �''�y���- .`�� Applicant is: Contr ctor / Homeowner �c���ie o�e� <br /> Email and/or Fax: �'���;„�/.�J /� � .-,�:,/. <<�.-�., <br /> PROPERTY OWNER INFORMATION: <br /> Name: �..i S(� �'Y�Z.�'11 i�l. <br /> Phone (day): 1 Y9� i_0..K,-e.V�CW i{Xff1CR.. <br /> Address: (�pYtq �� 5��,r- 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: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New 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 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �' �'�' <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />