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. . <br /> , � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � � �T O�I `-� <br /> PO Box 66 <br /> �Q Crystal Bay, MN 55323-0066 Date received: 9 ' <br /> Street Address:' eceived by: R -_.� <br /> y ,� 2750 Kelley Parkway Plan review fee: /� • �7 �'C <br /> �'� c? Orono, MN 55356 ������� __ <br /> �kESHO��' 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z�43 S d,r'�. �, pco� rv�t�S SS3� f <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 approva/60 days prior to the event. Shuttle bus seivice will <br /> required unless applicant demonstrates su�cient on-site parking is available. Nony�ermitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: ���� <br /> Name: <br /> State License# �---y 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: �`Tc kk � �y ��w�,,as <br /> Phone(day): ��-59�-7�t1> <br /> Address: _zS85 l�dr.r6.A+re_ City: c�roc•�o ZIP: S S �3 3� <br /> Email and/or Fax �_�a.� yo�,��„�;,, .,, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: ��'`� (�jL--� �'� �`�cC <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 �peck �Q Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation 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 movement may require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed DisUict MCWD ❑ P�vate 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 /> www.m innehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ � �� � <br /> �—� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />