Laserfiche WebLink
. ���� �� ����� <br /> � ��I��O�� ����I� ����������� . <br /> FOR NEW STRUC°TUR�S OR �1DDITIONS <br /> � MailingAddress .:.::::::::: :...�:?::::.:,::,:.::<,•:;. _ <br /> �-�� PO Box 66 �tiPermit;numb'er:"�":;.;'`` f.�:;�'�.��.':• <br /> : . .... ....... .. :... ::&��.� . ..:. `.::�;. <br /> `Q Crystal Bay, MN 55323-0066 �;Date received; ;l.�/=` . ' /�?, : <br /> � �. ;;s;:;::, .. <br /> ` � StreetAddress:' � Fteceived by` ' CM- <br /> ���. ; . -� �� � 2750 Kelley Parkway � „Plan_review•fee: �. 7�.J�, C� . <br /> �q:.�. . �,�� Orono,MN 55356 ;,... ....�O/7—D�.3�v ' ) <br /> !��st�o :o a - <br /> Main: 952-249-4600 = Fax. -2-249-4616 www.ci.orono.mn.us <br /> This application;form riiust.be�completed.�in�fu,ll;arid'ali;requi�ed,:information�:must:b�e,;submiited; <br /> Incomplete applicafions:will�be returnetl: (Please print) ��vYVaG� S�/Irr��`� <br /> GENERAL INFORMATIOM: <br /> Job Site Address: 7 �t� a�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No <br /> lf yes,a specia/event permit is required with Police Depa�tment and Cify Council approva160 days prior fo the event Shuttle bus seivice will be <br /> required unless applicant demonstrates sufficienf on-site parking is available. Non-permitfed evenfs will notbe allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: t,�`•�,79�� gt,°il�'�?�S ti�:G. <br /> State License# �b()2 92� Expiration Date: 3��i•-ZbJ� <br /> Phone: (celq�f�- �,�-35�8 (office) 95Z -�5--c35�3 <br /> Mailing Address: i 1�7 g L�3�Gitut.,� D�.�1� Cit : .,!Ja,�-��,q ZIP: � $ <br /> Contact Person: �-rr �4'� Applicant is: oritractor Homeowner (Circle One) <br /> Email and/or Fax: �i u�,�ru$ �d w� q ���:i�s �t�� <br /> PROPERTY OWNER INFORMATION; <br /> Name: ���. <br /> Phone(day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER 1NFORMATION: � <br /> Name: S A;v�� I <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFOf2MATION: Descri tion of ro"ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construcfion ❑Singie Family wifh �Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bidg. °,�(Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑Privafe Sewer <br /> ❑Other:(specify) �Multiple Family/Condo ❑Warehouse <br /> ❑Pubiic ❑Storage �'Public Water <br /> �:.�1ny earth►novernen4 mdy a�sa�cy�ira ❑Commarcial ❑Other(specify) <br /> MCWD review&permits. ❑Industrial : ❑Private Weli <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef:(speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehaha creek.or <br /> Estimafed Construction Valuation (excluding land) � 3.5�� �'�J <br /> . r�tc:tr�V�� <br /> A�R 14 2017 <br /> � ���'�F ORONO <br />