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I � _ <br /> , <br /> , City of Orono <br /> , � <br /> '� Buiiding Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: � D�� —dQ � ' <br /> �O�Q Crystal Bay, MN 55323-0066 Date received: �7 <br /> , I StreetAddress:' Re�ived by: �-� TCt%� �c <br /> y ,� 2750 Kelley Parkway � % 1,� - ��'S <br /> F� c,` Orono, MN 55356 �-2� �(1P � F►an reviewfee: �� .. <br /> 1KfSHV�� Main: 952-249-4600 otal ee: <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: n� D M <br /> Will this be a Parade of Homes, Remodelers Showcase H e or other isplay 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 wi 1 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA T INFORMATION: <br /> Name: �« l,�t„� <br /> State License# Q E ir tion Date: <br /> Phone: cell office <br /> Mailing Address: ^ ^ O*N Cit . ZIP: -Z <br /> Contact Person: ' Applicant i • ontractor / Homeowner (Circle One) <br /> Email and/or Fax: _ � ` <br /> PROPERTY OWNER INFO�MATION:� /� <br /> Name: ���1`t �%���[r►�4V <br /> Phone (day): —' r— <br /> Address: g� � City �ou�� ZIP� s�3�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _�j�ft� ���/�/.c�c. <br /> Phone (day): 9SL- ?4�- 7?0� <br /> Address: 7' �; City: /� p ZIP: ;S"�'Z <br /> Email and/or Fax: M�KF Q��y,Q��T, a� t �r� <br /> PROJECT INFORMATION: Description of ro'ect: ..5 �G�--f-�- 1�1� `� �-�=j��Sf7!'1 �.EC";k- <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Dispos & � <br /> �❑ N w Construction Sin le Famil with �Nater Supply <br /> 9 y ❑Accessory Bldg./Garage � ���� <br /> Addition attached garage ❑ Deck ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached ara e �� � <br /> ❑ Other: s ecif g 9 ❑ Residence ivate Sewer <br /> � P Y) ❑ 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 8�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �ther: (SpeCify) . Other(specify <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 ,��� a'�'�f <br /> Phone: 952-471-0590 ��r �UA� <br /> Fax: 952-471-0682 Sj.�YL� ���� <br /> www.minnehahacreek.or <br /> $ /� �-�= <br /> Estimated Construction Valuation (excluding land) ��•.�, Q pQ. <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />