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c��r oF oRoNo <br /> BUILDlNG PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �,Q� Mailing Address: � <br /> Q PO Box 66 �:il Permit nwi�er: — �[1 <br /> � � T <br /> Crystal Bay,MN 55323-0066 � Date r.eceived: --- –� –J'� <br /> Streei Address:' Receiyed by' ` ( <br /> y� L�� 2750 Kelley Parkway �����`I � `' l <br /> � t1'rf S H O��' Orono,MN 55356 n reyiew fee: –y�-;`�f�,� . <br /> Main: 952-249�60Q � � i <br /> Fax: 952-249�616 •Total•Fee;, � �g� �./� <br /> www.a orono mn us ' c�v <br /> ThisYapplicaUon fomi must�be completed+�n'fulf and all°Cequ�red informatronfmust be sutimitted; <br /> K' Y �°a A i a�:�.: P .- <br /> Incomplete,app icadonskw Il;be retu e „ (Plea pri f) <br /> GENERAL INFORMATION: � �a j� � � �� / � <br /> Job Site Address: I 6 � �1 j � ��,� I� S ��'� <br /> Will this be a Parade of Homes, Remodelers gh wcase Home or other Displa Home? Yes <br /> Nyea,a special event pemiit;$re�Wr��h paice DepeKm�r�l end City Coundl epproval BO days prlw to the e�rent. ShutNe bus service � NO <br /> �equired unless applicarrt demonstrates suR'icient on-site parking is availa6/e. Non.perm/hed events wip not be aHowed. <br /> CONTRACTOR/APPL INFORM ION: <br /> fVame: r� ,�.S /Lt. �� <br /> State License# <br /> Phone: •��N Ex 'ration ate: <br /> Mailirtg Address; L,/ 2/ �Ce �C��( <br /> �`` Ci : <br /> Contact Person: - � <br /> Email and/or Fax: ' `� ApP���nt is: Contractor Homeawner (Cireb Ons� <br /> �l.. n/. <br /> PROPERTY OWNER i RM TION� <br /> fVame: ? (�,j j <br /> Phone(day): <br /> Address: � /� � <br /> Email andJor Fax ��t � � �r � ZIP: �� ��� <br /> M�.; <br /> ARCHITECT/ENGINE INF RMAT ON; <br /> IVame: w <br /> Phone(day): <br /> Address: L(p � . <br /> Email and/or Fax: � C�t � ; /�f,iJ Zlp: .� ! f C' <br /> � , <br /> PROJECT INFORMATION: Descri tion of ro'ect; � / 1� � <br /> 1.Ty�e oi Project � �"� <br /> 2.Proposed Use 3.St►ucture Type 4.Sewage Dlsposal& <br /> ❑ ew Conshuction ❑Single Family with ❑ c�s 9 9 Water SupP�Y <br /> Additlon attached garage Deck �B� �Gara e <br /> Accessory Building ❑Public Sewer <br /> ❑Relocation ❑ Single Family with ice/Commercial <br /> ❑Other.(specify} �� detached garage ❑Residence ❑Private Sewer <br /> ❑Multipae Family/C�do ❑Retaining WaN(s) <br /> "'Any earth rr�ovement ma also re uire o�b'�c 4feet or greater ❑public Water <br /> Y 4 ❑Commerciai ❑Storage <br /> MCWD review$permits, ❑Industriai <br /> Minnehaha Creek Wetershed pisMct(MCWO) ❑Warehouse �p�jys�yy� <br /> t532o Minnetonka Blvd ❑a�er: (specify) ❑Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minn . r <br /> Estimated Construction Valuation (Qxcluding land) s (�Q(� <br /> Laat llpdeted: January 2016 <br />