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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: , <br /> � �Q PO Box 66 Permit number. ZD I,j— � � <br /> Q Crystal Bay, MN 55323-0066 Date received: 2 Z�J� (� <br /> Street Address:' Received by: �J <br /> y ,� 2750 Kelley Parkw �(( � <br /> `� � �� Orono, MN 55356 ��� PI� review fee: <br /> `�kfSHO �' Main: 952-259-4600 2015 Tota F e: <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: �j ��j � v�L � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf 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 INFORMATION: <br /> Name: ,� �Ownes ��� <br /> State License# Q[,2.(�°1(�Q, (P Expiration Date: U 5 <br /> Phone: cell 6� N�q office �b� y Z 3 3 3 <br /> Mailing Address: �7 o a 2 y�,7-}- `sk l.�C� i(�v� Cit : G�o�e ZIP: �� � � <br /> Contact Person: /j�d,� �,tJa� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: yv�p,r �Q ct-4-�aS �lb yN�S wt yt, , �o� <br /> PROPERTY OWNER INFORMATIO�V: <br /> Name: �'4'��kS �o�S �'^�-- <br /> Phone(day): 7 Z� 3 3 3 I� � <br /> Address: ��S F� h �t 1� Cit : 6'�.- ZIP: �S 3� � <br /> Email and/or Fax �u✓ �L�,��,�� hb ,,,,� s �,,,,�w- �o,,,,� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � i`t�. �.� ,� Qe�,` r� <br /> Phone (day): 3 1 S <br /> Address: � � �go � Cit : d Sst(� ZIP: �j S 36� <br /> Email and/or Fax: ;�i-}r� q � 1/I SI - �ov+/� <br /> PROJECT INFORMATION: Description of project: <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 ❑ Deck �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 ❑ Gommercial ❑Storage <br /> MCWD review&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.mi nnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ , � Q � �O� , Q(� <br /> Packet Last Updated.� January 2015 � <br /> Page 20 <br />