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. � <br /> � � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � <br /> , � _A�� Permit number: � O I G� —bQ C � <br /> (� � PO Box 66 <br /> `� C stal Ba MN 55323-0066 <br /> Q \`�, rY Y, Date received: /� a <br /> � <br /> StreefAddress:' .____. Re�ived by: ��.� TGt%K� � <br /> '� �� 1,, 2750 Kelley Parkway � �-- �-{ �r�+S <br /> �f� ` Orono, MN 55356 C� C Z� � (��(�l Fian review fee: �� • <br /> \ � . <br /> \��"�s�i���� ' Main: 952-249-4600 �--� otal ee: Oz <br /> -- Fax: 952-249-4616 www.ci.orono.mn.us �2-3 . <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) �m�, ���/�� <br /> GENERAL INFORMATION: ,�n <br /> Job Site Address: !1M D /'I <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: u«, �-.�-'��- <br /> State License# Q E ir tion Date: <br /> Phone: cell (office <br /> Mailing Address: ^ p*N Cit . ZIP: ,s Z <br /> Contact Person: /+�j ' Applicant i : ontractor / Homeowner (Circle One) <br /> Email and/or Fax: -7 � � � <br /> PROPERTY OWNER INFO MATION: <br /> Name: ��� ,5 j��t�y�QV <br /> Phone (day): <br /> Address: �� ���j �, City: �ou�� ZIP: 5'"�"�4-- <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Fjc{f� ��c��/.�c.., <br /> Phone (day): 9sL- 7sF�- 7?pL� <br /> Address: q-96 �/ 22 p7' y; , City: f�QO Z�P� SS��Z <br /> Email and/or Fax: Mi K6 Q(t�I3cHkJ�Qg�'Ti eE /s . Or/ <br /> PROJECT INFORMATION: Descri tion of pro'ect: .5G �G�� �.•}�� `�) «'-S�l S�7'Y� ' ���'�c- <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Dispos 8� �� <br /> `/ Water Supply <br /> ❑ N w Construction �Single Family with ❑ Accessory Bldg./Garage �. ��� <br /> Addition attached garage ❑ Deck ❑ Public Sewer � � <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial }� � <br /> ❑ Relocation detached garage ❑ Residence ivate Sewer I � fi <br /> ❑ Other. (specify) ❑ Multiple Family!Condo ❑ Retaining Wall(s) f <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) �ther: (specify) . Other(specify� <br /> 15320 Minnetonka Blvd � <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 �D�� �UA-- <br /> Fax: 952-471-0682 ,�/�qc.G �'"'��1/�,.� <br /> www.minnehahacreek.or <br /> $ �_ <br /> Estimated Construction Valuation (excluding land) ��� ��� • <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />