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� ! <br /> rity of Orono <br /> ' Permit Application '�C�� ��•7� � <br /> �,����� ��� �actures or Additions <br /> O � �"`" � Permit number: p�l '-'�/� <br /> g � � � � _� <br /> Q O � ��� ! 55323-0066 Date received: �Z-"�� � � <br /> �`� ��l,v ' r ` Received by: � r l <br /> � � a rn� �l, � ' - J �p <br /> � �Gti�' (�„��1° _ �.eiley Parkway � -' Plan review fee: � O � <br /> -y$�8xo4 Orono, MN 55356 d�0 3 -O � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �(c.,,� ��,�c:��.v L!t-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 Counci!approva!60 days pnor to the event. Shuttle bus service i e <br /> required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: G �.��`_x:"� �,'�„S <br /> State License# � , � Expiration Date: �' f 5 <br /> Phone: 7 " - c�'' �. �, office �, � - �=;r cell <br /> Mailing Address: � ,k,� � ° Ci � c - ',.v• ZIP: �,"r j t; <br /> Contact Person: r,,,J,�-,�rR,�, Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ` � f `�� " �,�r��,�N �ti, �_ - _ c_�;,s.� <br /> PROPERTY OWNER INFORMATION: ������� � `��'����� �����'�"���� <br /> Name: 7'c�,c� ,f-�`i�'kY1-/��� K�.c.,2..,v��L.. <br /> Phone (day): 7(�.�"5 �Z7. �7�j`� . 'ln- <br /> Address: �q[��CU -� ��l'c r.�S n��v.�.- City: �LCYJIt��... ZIP: ?�'�-3 <br /> Email and/or Fax RN-��.�c, ku.�nr�b�-c� �.�;h��l-�L .��M <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: l°) �'� <br /> Phone (daY): _�� � ��,� 'j��c:�� . <br /> Address �(ic� La�(fi.u.�,�r, `��. N�'. CitY� ��Ificr:;� ZIP: S`�f�f�� <br /> Email and/or Fax: "Zt,,= "3 . 7 4;�- hc�- L'� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> �New Construction �Single Family with �esidence <br /> [�]��ddition '�attached garage arage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Pubfic Water <br /> "'"Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ��Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ ��(�(�'��-� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />