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A <br /> �•� • � <br /> ����� W ���n' of Orono <br /> � y <br /> �7�� �J�id (y� � w-- 'ermit Application <br /> ictures or Additions <br /> .� . Permit number: �� S����i-� <br /> � �N 55323-0066 Date received: •Z.. — <br /> ___ . <br /> _,. _. ....__ . . <br /> _.m....� ..__._�_ <br /> �. . ..__.__ ... .,�, <br /> y�' ' � 356 a�?�-•}�5 �-���� Plan review fee: P �G� <br /> tq� �O _. ----..� _......____- <br /> _. .— -�21{�C2'_""..______.�_ <br /> D V/1/�/dl'4'.CI.GI"Vl�li) I' �"I.US <br /> I in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �`�� �-�� ��- S �ic-{�f! �� . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,e(No <br /> /f yes, a special event permit is required with Police Department and Cify Counci/approva160 days prior to the event. Shutt/e bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO,R, �ATION: <br /> Name: �'116T�- /V'��%�� ��-�,��/c.�:��-rU� <br /> State License# ���;����r� Expiration Date: `� - �j--Z���7 <br /> Phone: cell -� _ -���- office {_ � <br /> Mailing Address: �,� �, � � Cit : _c>/(,.��� ZIP: ��35 . <br /> Contact Person: p � Applicant is: ContractoF-r Homeowner (Circle Orej <br /> Email and/or Fax: -� D^ S d �1 •���,��-C o v� <br /> PROPERTY OWNE INFORMATIOrN: <br /> Name: �,c c..A V w�f�� <br /> Phone (day): <br /> Address: 7��/S p/`�- S �l v� �"� City: ����j ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATI N: <br /> Name: ��� '�> ,t SS �ic-cfv�«-� ��c l•��� �' s <br /> Phone (day): c.z _ ����� � <br /> � �— <br /> Address: �,� t�-7 �o�ts �- S�. City:��.�.�v� ZIP: � �C�z <{ <br /> Email and/or Fax: <br /> l� � <br /> PROJECT INFORMATION: Description of project: Z�'x �Z f`v�' S�`'� �r f �jv �`S.� � <br /> 1. Type of Project 2. Proposed Use 3. Str�Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with Accessory Bldg.+6e�a�� <br /> ❑��dition attached garage ❑ Deck ❑ Public Sewer <br /> I�'Accessory Building ❑ Single Family with ❑ 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 require ❑ Commercial ❑ Storage <br /> MCWD review�permits. ❑ Adustrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District MCWD �� ( p (y� ❑ Other(speCify) <br /> ( ) Other. s eci <br /> 15320 Minnetonka Blvd �f��� �,�,,�� � �G���, <br /> Minnetonka, MN 55345 �� <br /> Phone: 952-471-0590 �� t�cf �'�'�l % � �-S <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ g�, ��� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />