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� Ci�y o� Oror�o , ___ _ _ _ <br /> � � E3u�ldin� Perm�t i4pp�icatio� O�8/o- �'� <br /> for �levv S�r�ct�res or �4c�ditia�s -- <br /> Mailing Address: <br /> Q PO Box 66 Permit number: � G�/7- /�c Gj�> <br /> +� C stal Ba MN 55323-0066 <br /> � � ry Y� Date received: ��-/Cj- <br /> Street Address:' Received by: -�'y <br /> y ,� -' 2750 Kelley Parkway �Q; l��, �> <br /> �' � �` Orono, MN 55356 Plan review fee: <br /> �aKESHO��' Main: 952-249-4600 Total Fee: ����1-���'�� <br /> Fax: 952-249-4616 vrw�ti�.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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �f <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> lf yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non permitted events will not be allowed. <br /> CONTRACTOR/APP CANT IN ORMATION: <br /> Name: /��i/ e �( ��' L . <br /> State License # xpiration Date: . <br /> Phone: cell Z.. 2. _ Z office �j' 2- ,S'_ <br /> Mailing Address: � / i y . Cit : r Z�p: <br /> Contact Person: J� Applicant is: Contr�acto; / Homeowner (Circle One) <br /> Email and/or Fax: C C G/'VI <br /> PROPERTY OWNER INFORMATION: <br /> Name: _�D/YJ G1� �1�.�(df�liS <br /> Phone (daY)� �O�l�- 3Z,�7307 <br /> Address: �(a�J�/r1���.1i�t�t �Qo•( City• (�}/LVjp ZIP• 55r�S� <br /> Email and/or Fax K,�,v�h��}c� y.�G �� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��P�G►Gs!i1 � ��jl��1 • <br /> Phone(day): <br /> Address: City. Z�P, <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATtON: <br /> Name: <br /> Phone(day): <br /> Address: Cit : Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: N�Gt/jGf , <br /> 1.Type of Project 2. Proposed Use 3. ructure Type . 4.Sewage Disposal& <br /> ❑ New Construction ❑ Sin le Famil with �Nater Supply <br /> ❑Addition g y ❑ Accessory Bldg./Garage <br /> attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer <br /> ❑ Relocation /,, detached garage ❑ Residence - <br /> � P fY) L��/Gt��4� ❑ Septic <br /> �Other: s eci. � ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet orgreater may be required) <br /> *"Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) � Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.ora <br /> Estimated Construction Valuation (excluding land) $ �_T��� •.� <br /> Packet Last Updafed: January 2016 <br /> Pa.qe 21 <br />