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� <br /> . • <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �� 5��� <br /> QAT PO Box 66 Permit number: <br /> � �vQ Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' ' --- <br /> y ,�- 2750 Kelley Pa a <br /> �'� ���� Orono, MN 5535 �15��,��� Plan review fee: � •� P ��p <br /> kFSHo Main: 952-259-4600 <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 prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: ` s`�� 0�'�. ,s �v�l ��, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> lf yes,a special 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 s�cient on-sife parking is available. Nonyoermitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR AT ON: / � <br /> Name: / L O/'� �J�/'c-G 7�7U <br /> State License# gQ p Expiration Date: �-3/_�1-� <br /> Phone: ceU —pp office {, <br /> Mailing Address: � � ,� Cit : /(/� ZIP: SS3S <br /> Contact Person: B Applicant is: ontract Homeowner (Circle One) � <br /> Email and/or Fax: p^ ,� Q �q� -�d <br /> PROPERTY OWNE NFORMATION: <br /> Name: �.9�,c �a � w�r-A.. � <br /> Phone(day): <br /> Address: p/� S� �a� �°'• City p,��/t� ZIP• <br /> Email and/or Fax <br /> � <br /> ARCHITECT/ENGINEER INFORMATI N: <br /> Name: v� �s � SS �i�G�� �� l�/�� r s <br /> Phone(day): ��/ _ ���—2 �� <br /> Address: �6 �--7 ��s,� �,�- Citv'��� Zlp• ,�,�pZc� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: �1'� /Z f'w� S�� ��� 7� `jv dSe.� � <br /> 1.Type of Project 2. Proposed Use 3.Struct Type 4. Sewage Disposal 8 <br /> ❑New Construction Water Supply <br /> ❑Single Family with Accessory Bldg.f6erage-- <br /> ❑ dition attached garage ❑ Deck ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑Other:(specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> P Y ❑ Retaining Wal�(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ I dustrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District MCWD ( p (y) ❑Other(speCify) <br /> ( ) Other: s eci <br /> 15320 Minnetonka Blvd �� �,���� �/� <br /> Minnetonka,MN 55345 � � f V DN� <br /> Phone: 952-471-0590 ���� �M! % �- f <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ g�, Q�(� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />