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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: -� , `�_�, S.� �' <br /> p, PO Box 66 Permit number. �.—L� ` � � <br /> �O`V(� Crystal Bay, MN 55323-0066 Date received: --' 1�- l �� <br /> Street Address:' - - __ Received by: � �, <br /> � � <br /> 2750 Kelley Parkway ZG�c� � ` ��' Plan review fee: � �7 , ��� ;Z. {w(� <br /> �' �` Orono, MN 55356 �` -------�-�-�_____- - �j�sZ`l <br /> lqkfSH��� Main: 952-249-4600 Total Fee <br /> Fax: 952-249-4616 www.ci.orono.mn.us j �(�. <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) � �� f_�C� , '�� <br /> GENERAL INFORMATION: �G <br /> Job Site Address: � '�� ,��/ - <br /> Will this be a Parade of Homes, Remodeler 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/AP�.IC T INFORMATION: <br /> Name: �tl����A. �.,.a�l �� ', <br /> State License# ,(;`_U 3//��/ Expirati n Date: <br /> Phone: cell I � -7'G(t office � - 4/" ��'' <br /> Mailing Address: �' Lli /yD I Cit : ,{3,,�:,� �p' � A'KZIP: ��" <br /> Contact Person: �„� ah ��l q,,l Wqi � Applicant is:; _ra flr /; o CircleOne) <br /> Email and/or Fax: �.�,, � -�� �h o'1 y. c�.�1 <br /> PROPERTY OWNER I FORMA ON: � . ' <br /> Name: �� �, U�1 \'1��1( '� I- ��j1li��l;'i � ��-V����„i j"- <br /> Phone (day): <br /> Address: City: ZIP: <br /> Emailand/orFax �(;i1�,������y���;111 ���,j"ti��l �C�6'1bU,f �(PJ�'► <br /> ARCHITECT/ENGINE R INF ATION: <br /> Name: l,ar vb'�-� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro�ect: � <br /> 1.Type of Project 2. Proposed Use 3.Structure ype 4.Sewage Disposal& <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 ,�Public Water <br /> *"Any earth movement may require ❑ Commercial ❑ 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 L <br /> Fax: 952-471-0682 �, <br /> www.minnehahacreek.or <br /> �� � <br /> Estimated Construction Valuation (excluding land) � � ���'" ' �'� <br /> � ��� <br /> Packet Last Updated: August 2015 �v� 1 ��O <br /> Page 21 <br /> Z� l <br />