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[,,,• . <br /> a� <br /> .d•�� <br /> City of arono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ��A y Mai1rPC3 Box fifi, i'ermil nur�tber: '�3 <br /> `v� c�ys�a��ay,MN a5323-0068 oa�e r�ce�vea: l —z 5—� <br /> sr.�rAddf�ss:� �rs�by: � , <br /> "" � 275U Kellsy Pa�kway � <br /> �y� �(�� an�visw fse: � <br /> Q�c.` Orano,MiV 55358 �—Z"7 5Jv <br /> �'�FSH� Main: 952-249-460� <br /> fax: 952-2+49-4616 <br /> This ap��on �Cum mu�t#a+�t� �a futi a�d�1`r ` ��n�ian rn�t b�subrrrr��d. <br /> inc�m�r�e�i�n��rill be retu�nsd. (P/ease prinf) <br /> GENERAL INF4RMATION: <br /> Job Slte Address: q <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dispiay Home? Yes No <br /> H yes,a sped�l event perrnit is re�rired wrth Pvficie De�arhn�t�hcJ Clty Coun�►7 approv�i fi0 days prior to tl�e eVent Shuttle bus service wt7l be <br /> required unfess appNcant demonstratas sufiScieM on-sifa parkirrg is avalladJe. No»-p�rmitted events wiU nof be a!loweat. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: <br /> State License# , Expiration Date: <br /> Ptwne: (c:eil) � (offioe} <br /> Mailing Address: Ci Z1P: <br /> Contact Person: Applicant is: o trac r 1 omeowner (Circte�no1 <br /> Email and/or Fax: <br /> PROPERTY OWNEF�INFORMATION: <br /> Name: ��,g� �"�iK` � ��ai.L� <br /> Phc�ne(c�y): <br /> Address: _i�00 ��.�cL�.r. fa.r Ciry:�yr��tl ZiP; �'���7 <br /> Email and/or Fax <br /> ARCFiI'TECT/ENGINEER INFORMATION: <br /> Name: ��3C��� . <br /> Phone{day): <br /> Address. �IoP� [�s�.�.s.�� Ciry: ��.�s—,;�,L ZIP: SS'��'� <br /> Email and/or Fax: _/�C-r.�:���i_� e���H <br /> PROJECT INFORMATION: Descri �on o� ro'ect: <br /> 1.Type nf Project 2.Praposed Uae 3.Structure Type 4.5ervage Disposal� <br /> New Construction �Sin le Famil with rNater 8upply <br /> g y ❑Accessory Bldg.!Garage <br /> ❑Addiiion attached garage ❑ Deck Public Sewer <br /> ❑Accessory Buiiding [� Single Family with ❑OffIcelCammercial <br /> Q Relxation detached garage ❑Residence ❑Privaie Sewer <br /> ❑Other:(speaiy} ❑Muftipie Famify/Condo �R�ataining Wall(s) <br /> ❑Public 4feet or greater ❑Public Water <br /> ""Any earth movement may requlre ❑Commercial ❑Stara�e <br /> MCWD revlew&permits. ❑Industrial ❑Warehause �Private Well <br /> Minnehaha Geek Watershed Qistrick(MCWp) ❑Other: (spec'rfy) ❑C7ther(specffy) <br /> 15320 Minnstonka Blvd <br /> Minnetnnka,MN 55345 <br /> Phorte: 952-471-0590 <br /> Fax: 952-471-C3682 <br /> Ru 11 9ek.cx <br /> Estimated Construction Valuation (excluding land) � 7�Q_ �zp -�— <br /> Packet tast Updated: August 2015 <br /> Page 2i <br />