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� - <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Marling Address: <br /> i��� PO Box 66 Permit number: b��._�L�7 <br /> / (� � Crystal Bay, MN 55323-0066 Date received: —f�'—(`� <br /> / , <br /> ( � Street Address:' iverl�,T � �,� <br /> � � � 2750 Kelley Parkway j� —� PI n review fee: �(J�� <br /> �` v�� Orono, MN 55356 � � <br /> �qk�'s'�i�4�".f Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compaeted in full and ali required information mus#be submitted. <br /> Incomplete apptications will be returned. (Please print) <br /> GENERAL INFORMATION: P�S � � <br /> JobSiteAddress: p ar,�s� rrns Lan�� Drohd� � lJ 553� �/ <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 approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applrcant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATI N: <br /> Name: iQm-e�1 �cns��vc�on InC• <br /> State License# �c6 o a� �y Expiration Date: 3 3/ �a/ <br /> Phone: (cell) 7C�;. a ►3 . S8 9 S office 7GT,. ya-$. yysry <br /> Mailing Address: S 7LS va ++� �-� Cit : S . %���+�/ ZIP: S' 37 <br /> Contact Person: /3 e N�"Q rn�P/� Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: b c ��Y � co h 5 vc �ch, f a w� <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 /> PROJECT INFORMATION: Descri tion 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. I Garage <br /> �Addition attached garage ❑ Deck � Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage � Residence <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ❑ 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&permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well <br /> ( ) ❑Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wwvd.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� Q�V <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />