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� City of Orono " <br /> Building Permit Application � � �� �/ � , `�-�� <br /> for New Structures or Additions <br /> Mailing Address: �� 1 -�j-c�l `� <br /> �Q A>O PO Box 66 Permit number: _ <br /> `V C stal Ba MN 55323-0066 <br /> rY Y, Date received: � ` <br /> / Street Address:' _ _ .eceived by: � - <br /> _._. • <br /> � 2750 Kelle Parkwa `—f� �7 <br /> �F �' p� � ' Y y � � Plan review fee: /� • � 7 CC <br /> c, Y I� Orono, MN 55356 "�� 7���_.� <br /> tqkFSHO�� �J.__-..____ --- -__ <br /> 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. (P/ease print) <br /> GENERAL INFORMATION: x ��� � <br /> Job Site Address: 'Z S `c 5 �, r'�'c� ,�'�. C��U�-� �^ti SS �'3 1 <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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: G;-��� <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 /> Narne: ;� �« �-...� �ti1�'r'� �.–��v�..il,;ts <br /> Phone (day): r,��t-5�15 -7�'L �—� <br /> Address �� 5�;5 l,.�d�-�d :�-:-� City: c;' _� -� ZIP: `� S 3 5 � <br /> Email and/or Fax �,�;,,��,��, �= y.;�j,...,�,, -,� <br /> �----r— <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> I , - <br /> PROJECT INFORMATION: Description of project: <br /> �J �--{ti l�------ �- �/��. � �--� � <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> �New Construction [�Single Family with Accessory Bldg./Garage <br /> Addition attached garage �peck (� 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 ❑ 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �'�' � <br /> —�� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />