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� ' City oi� Orano <br /> � � �t���cfing Perr�it Ap�licatio� <br /> far �'e�nr Structures or �4dditions <br /> Mailing Address: <br /> ���j PO Box 66 Permit number: • b� � �� <br /> o Crystal Bay, MN 55323-0066 Date received: /Z9 '-!�—�(� <br /> Street Address:' Rec�ed by: �j}'1 / � <br /> y � 2750 Kelley Parkway - � -- <br /> `�t �� Orono, MN 55356 lan review fee: .�� � <br /> 'kfSHOR� Main: 952-249-4600 <br /> Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <br /> This application form must be completed in fuil and al(required infonnation must be submitted. <br /> Incomplete applicatlons wfll be retumed. (P/ease print) <br /> GENER�►L INFORIIAATION: <br /> Job Site Address: � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> /f yes,a specia!event permit is required with Police Department and City Council approvaJ 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non�ermitfed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: ��� <br /> Name: � <br /> State License# �� _ Expiration D te: <br /> Phone: cell � office <br /> Mailing Address: / " a• Cit : Z�p: �. <br /> Contact Person: M���qe SU1N��" Applicant is: C / Homeowner <br /> Email and/or Fax: _ �«� g.��W�) �,�+ (CfrcleOne) <br /> PROPERTY OWNER INFORMATION: <br /> Name: -TX�S���Tp}t� TLP.A� <br /> Phone(day): ��?=y�a <br /> Address: ���j_��„����, City �rx� ZIP ��j� <br /> Email andlor Fax +� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : Z�p: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : Z�p. <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure T e <br /> YP 4.Sewage Disposat& <br /> �v Construction Water Supply <br /> ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> ❑ Relocation 9 y ❑ Offlce/Commercial <br /> detached garage ❑ Residence <br /> �Other:(specify) ��(�/Gl�j � Multiple Family/Condo ❑ Retaining Wall(s) �Septic <br /> ❑ Public (Compliance certificate <br /> '"`Any earth movement may require 4-feet or greater may be required) <br /> ❑ Commercial ❑ Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed Distnct(MCWD) ❑ PubliC Water <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 � Othe�: (SpeCify) ❑ Other(SpeCify) <br /> Phone: 952-471-0590 / Fax: 952-471-�682 ❑ Private Well <br /> www.m innehahacxeek.orq <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />