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, ti � �/�� �sc►��; �4c�ep�r�r.�,-/ <br /> ,�L, " n.tohe� <br /> y . Ci(.-��/J��- �.L/f �.h��� CX��'i�7'�" <br /> Jz-�--�n-z <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �, Marting Address: d� �_ <br /> � PO Box 66 Permit number: ,. ;�,� <br /> �;�,,C�l�l.,\ <br /> j Q '�,, Crystal Bay, MN 55323-0066 Date received: _�� (��-j�I <br /> �� Sfreet Address:� , _____--�. eive�d-b�F� � �-�_ <br /> `�`�� , ,�, 2750 Kelley Parkway 7 �� j� - �.� <br /> � P�n review fee: �t�'� ` <br /> � �`i Orono, MN 55356 ��c� �K f� -_._ ------ _T.`_ <br /> ����tsr������,� Main: 952-249-4600 Total Fee: � `- ' �Z <br /> -�'" Fax: 952-249-4616 www ci oror�o.rnn.us <br /> This application form must be completed in full and all required'informatior� must be sub itted. . <br /> Incamplete appiications will be returned. (Please print) �!!�$� S��J(p��% <br /> GENERAL INFORMATION: / • I [� /J <br /> Job Site Address: g a�_��ST�rrn s LA�'I�� C�r'o n0� /I/1 '�/ S7 3� 7 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> (f yes, a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service wrll be <br /> required unless applicant demonstrates sufficient on-site parking is avarlable. Non-permitted events will not be allowed. <br /> CONTRACTOR J APPLICANT INFORMATI�N: <br /> Name: � ifm-e�1 �ons ruc�0l1� �nC• _ <br /> State License# �6 0�( R Expiration Date: 3 3/ aar g <br /> Phone: cell _7Cv',. a ►3 . SS 9�i ___ office 7G3, ya-$, yyS��/ <br /> Mailing Address: --S �LS_Qvp ►+a .,�_�-e. -------- --- ----------Cit : S _ ;��a�r/ ZIP: s 37 <br /> _. <br /> - -- . ..._ -- <br /> Contact Person: /3 n N�"�e rN�P/a Applicant is: ontracto / Homeowner �c���ie o�e� <br /> --- — --- ----- -- — <br /> Email and/or Fax: ���n ;�w+r j� co h 5�i-vc 'oh, C o t-n <br /> PROPERTY OWNER'I�V F RMATION• <br /> Name: N �1 �j���,(rQ� <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax N e y� � U� ��� n • ��jV� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> -- -------------- -- <br /> Phone (day): — ---- ---- — --- ------ <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro ect: <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 ❑ Derk � 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 /> ❑ Fublic 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 /> w�,nrw.mi nnehahacreek.ar <br /> Estimated Construction Valuation (excluding land) $ _���Q� _ <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />