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a , ,, <br /> City of Orono <br /> Building Permit Application � <br /> for New Structures or Additions <br /> 0 <br /> �p <br /> Mailing Address: Permit number: `L � `_� � �' <br /> �Q�O PO Box 66 � '�. <br /> Crystal Bay, MN 55323-0066 Date received: y Z�]I (t-7 <br /> StreetAddress:' �_----.__.Z Received by� ��J <br /> _�___ <br /> �- _.._.—_ <br /> y ,� 2750 Kelley Parkw � � �:� Plan re ' fee: " <br /> �' c,` Orono, MN 55356 ��,�, ��, r �_ __< <j �� ____ - -� <br /> ��KfSHO�� Main: 952-259-4600 �___..___.--=�-�"=+� T Fee: <br /> Fax: 952-249-4616 www.ci.�rono.mn.us f,:'>�_f L�V' k� ''� '�'i`_� <br /> This application form must be completed in full and all required i ation must be submitted. <br /> Incomplete applications will be returned � <br /> GENERAL INFORMATION: <br /> Job Site Address: ��( 7�;� (r � `�- �C�� �� �� <br /> Will this be a Parade of Homes, Remodelers Showcase Ho or other Di play Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Cou approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available on-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> � . <br /> Name: ^ �� � :- <br /> State License # �2� `\(� � G � �'�� <br /> Phone: cell Z . ' �,� �v�1� ��o ��r � <br /> Mailing Address: � o �,2 y..>t- '=�s l� l • <br /> Contact Person: �L ,L t,i'�� <br /> Ema.ii and/or Fax: �v�u r 'k— �' � Ia5 �c 4L1 r.> e �� � � ��_ <br /> PROPERTY OWNER INFORMATI _ � � <br /> Name: ;���-��a 1-l� uh�� <br /> Phone (day): _ � � �; " � <br /> Address: �'��5�- � Q�� \ ']1� /`� � <br /> Email and/or Fax , ur C: ����• VU l/ <br /> ,. ._ . , <br /> ARCHITECT I ENG ER INFORMAT � ` � +``�' `'`�' ' '' �` <br /> Name: _�,� ������� .���' r� ��' _, ,j _� <br /> � � _ � �1;`�^�'" �,�y�,,; � <br /> Phone (day): "�� ��, � � � • - r ' ��`��� � <br /> Address: s1 ��.�- � <br /> Email and/or Fax: ��,�hK a � r <br /> � /'�/�� ss �� e ,�e e�� <br /> PROJECT INFORMATION: Descri ,l.' J ��1 <br /> 1. Type of Project �e.�{���/G��'1 CZ° `�.df� <br /> 0 � <br /> � New Construction � � � ��L}� ��� � � <br /> Addition � / �l�- <br /> ❑Accessory Building �� �. � C 7 <br /> ❑ Relocation a�'C(� <br />' ❑ Other. (specify) U rnwuNic i a�����y� � <br />' ❑ Public ;r.�``"�� � �T�f- � 7 --� E' YI, <br /> '*Any earth movement may require ❑ Commercial ✓ � <br />' MCWD review 8�permits. ❑ Industrial �,,n � �Zu S ��, �� Ca G1 C��l� <br />\ Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) � / �1��i � <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 /> Packet Last Updated: January 2015 <br /> Page 20 <br />