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. <br /> • City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: permit number: Z(�� ,S� d <br /> QA, PO Box 66 <br /> � �`v� Crystal Bay, MN 55323-0066 Date received: 2 — 3-1 <br /> Street Address:' Received by: � <br /> y ,� 2750 Kelley Parkway ��C�� 5ao plan reviewfee: , (a Z. � C <br /> �' o� Orono, MN 55356 <br /> 1'�kFstto�`�' 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: L ,�r/ <br /> Will this be a Parade of Homes, Remodeler Showcase Home or other Display Home? Yes No <br /> !f yes,a specia/event permit is required with Po/ice Department and City Council apprnval 60 days prior to the event. Shuttle bus service will <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events wil/not be al/owed. <br /> CONTRACTOR/APP ICf� INFORMATION: <br /> Name: d"�cl�S�olA.2- �pwt��CY ���i <br /> State License# _�(�3 J/L�! �— Expiration Date: <br /> Phone: cell � . -7 o�ce �`i - <br /> Mailing Address: L 1' �D ' 1 Ci : rw y� � d'�IZIP: <br /> Contact Person: p q,,� Wq) Applicant is:��ra r I O Circle One) <br /> Email and/or Fax: � f� f-� ,"1 .Ga,.n <br /> PROPERTY OWNER I FORMA ON: <br /> Name: ��4vy-G <br /> Phone(day): ' <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEf R INF ATION: <br /> Name: /�Se�t vvt,�� <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATtON: Descri tion of ro ect: <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 ❑ Deck �f 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 �ublic Water <br /> ""Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othe�: (SpeCify) ❑Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minneh hacreek.o <br /> Estimated Construction Valuation (excluding land) $ ��J/� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />