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/� <br /> • R <br /> � <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> ��A r PO Box 66 1 Permit number: O�O!S- DO o`�Oo� <br /> `VQ Crystal Bay, MN 55323-0066����� Date received: o?-/7-/S <br /> StreetAddress:' Received by: � - <br /> yF ,� 2750 Kelley Parkway Plan review fee� ���� '� <br /> c,` Orono, MN 55356 <br /> ��kfSH��� Main: 952-259-4600 Total Fee: ��� �� <br /> Fax: 952-249-4616 w�vw.c..�.�ronu.rr�n.us � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will,be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��` � �— 3���'t� b--�� ���� ��/�' <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 Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT�NFORMATION: � ��_� �-- <br /> Name: � ' � � �/�l� L'�"��y � �'�-- <br /> State License# ' �' • ,3� Expiration Date: ��7 <br /> Phone: cell F, Z- 3 " - ! office ���=r-� <br /> Mailing Address: 3� --- {;� " Cit : ,�t �% .�a� ZIP: S'�'S 5� - <br /> Contact Person: �-, S Applicant is: ntr c r / Homeowner (Circle One) <br /> Email and/or Fax: � �.� r / 6r�� �. % �'��<-� • �� .�c«^ <br /> PROPERTY OWNER INFO� ION: <br /> Name: ,v � �/'/s�� <br /> Phone(day): . Z �' �' - y'GS' <br /> Address: �l/y�� �L8 � z�itC City: C��'•�G�G' ZIP: .�����', <br /> Email and/or Fax �.�;�-��,�^r1���� �•<S;� G 4":'�'� <br /> ARCHITECT/ENGINJF, R FORMATI N: ' ,�/�� <br /> Name: ///GZ r��l ���C ��y'��_ �� � �!�/�'f'1 � /��'1 � <br /> Phone (day): �,� -- . � .- <br /> Address: ���� �t/ 3�% ..59; ^ �� /�;C� City: .�`�.S ZIP: ,S✓��'/ <br /> Email and/or Fax: �,;z - �s�Z.7- ���i> <br /> PROJECT INFORMAIIQN: Description of project: <br /> 1. Type of Project /� 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> � Water Supply <br /> ❑ New Constru ion `',�96-C�� Single Family with �Accessory Bldg./Garage <br /> ❑ Addition ✓�/' attached ara e ❑ Deck ❑ Public Sewer <br /> � y 9 9 <br /> ❑ Accessory B ilding ��(�� ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation y� �}C/S��% detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify � ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movemenN�y_,rg,qu�e/ ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ;� Other. Sp Cify) ❑ Other(Specify) <br /> 15320 Minnetonka Blvd .( <br /> Minnetonka, MN 55345 �'� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.rriinnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �5 � <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />