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C11�Y OF �RONO , <br /> 1 Y � �, j <br /> �U�LDiNC� PERIVII� 14PPLICi4TIOIV 1��1, ��r <br /> FOR �VEVN �TRIJCTURES OR 14DDITIONS <br /> /�� Mailing Address: <br /> �O` �O PO Box 66 Permit number: p/(�— d/D 5� <br /> Crystal Bay, MN 55323-0066 Date received: O �����o <br /> � Street Address:' <br /> � � Received by: <br /> �'� G� 2750 Kelley Parkway(� � ��i� Plan review fee: / —Q/(�s , <br /> `qxESH��� Orono, MN 55356 1' ,W �� <br /> Main: 952-249-4600 �� Total Fee: %��� 9v <br /> Fax: 952-249-4616 ��nww.c.i.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 prinf) <br /> GENERAL INFORMATIO[V,• � <br /> Job Site Address: �(� ��U /��• �� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,� No <br /> /f yes, a specia/event permit is required with Police Department and City Council approval 60 days prior fo fhe event. Shuttle bus service wi11 be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: � /2��%, '����2S <br /> State License # '7 3y Expiration Date: ' ;2q ) 7 <br /> Phone: cell 6 � 2 - 7 _ C� office �v� <br /> Mailing Address: �3b"7 7S 5i N�% Cit : Dr '� Gv ZIP: S j 3� ±� <br /> Contact Person: �� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: �'N Fv � ,��u/�,N�Y�xc2'-✓Z;�2S ��v�`'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �� �J�h2-S'� <br /> Phone (day): C�/2 - / - 7�,7 <br /> Address: Gf(�Y c� . ,/a,,QM �Z City: ✓�'1���%� ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ ew Construction Water Supply <br /> ❑ Single Family with ❑Accessory Bldg./Garage <br /> [Y�Addition attached garage ❑ Deck <br /> ❑Accessory Building � Sin le Famil with ❑ Public Sewer <br /> g y ❑ 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 also require ❑ Commercial ❑ Storage <br /> MCWD review 8� permits. ❑ Industrial ❑Warehouse � Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Othe�(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 R E C E I V�:;� <br /> www.minnehahacreek.or <br /> $ � t�<,_ AUG :�' �', `"� : <br /> Estimated Construction Valuation (excluding land) � � QQ <br /> C1TY OF ORONO <br /> Last Updated: January 2015 <br />