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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p � —� q <br /> QA, PO Box 66 � <br /> � �v� Crystal Bay, MN 55323- D66 Date received: 5 — <br /> StreetAddress:' `�l�r� Received by: J� <br /> � ,� 2750 Kelley Parkway <br /> y�' �` Orono, MN 55356 ����'� Plan review fee: /4/'�, . <br /> t�'rESH��� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us ���• <br /> This application form must be completed in full and all required information must be ubmitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 113s LGM A I-I�UA YC �2on(o rv�Pl 5536�{ <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 Po/ice Department and City Council approval 60 days prior to the event. Shutt/e bus service i/ be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: 1�1'bp���7' bwY1c(' <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �b�}�( U..I M012�S j <br /> Phone (day): �.63��t 0• l S i'� '/ <br /> Address: I►3S Lvn-+r� I��►�Dlk /-�vC City: Q2Gw0 Z�p; S,S�6'7 <br /> Email and/or Fax ���h,.�. ,,,� oras�- � ct w►a� I . CoM <br /> --o <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: /� a <br /> Phone (day): <br /> Address: Cit : 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 8� <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 <br /> �] Other: (specify) �CG ❑ Private Sewer <br /> k- ❑ 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&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.m innehahacreek.or <br /> � <br /> Estimated Construction Valuation (excluding land) $ I�� ��� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />