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b � .�� <br /> -� � Ci of Orono �� <br /> � • � �l <br /> Building Permit Appl�cation <br /> for New Structures or Additions _ ps <br /> Meiling Address: Permit number. � <br /> PO Box 66 <br /> �01vO Crystal Bay,MN 55323- 1 Date received: _� <br /> ��V/ Received by: D�.� <br /> Street Address:' '1. � Plan review fee: D S_ <br /> � 2750 Kelley Par�y � ��_ ! <br /> Orvno,MN 55356 <br /> �`�t,���SHo�,��� Main: 952-259-4600 ci.orono.mn.us To e' � <br /> Fax: 952-249-4616 �►� \ <br /> This application form must b e$mpca��s���bea1re�tu�m�d d��ea�a print)ust be submitt <br /> lncomplet pp <br /> GENERA� �NFORMATION: v� �3°►I <br /> Job Site Address: 3 3S <br /> va160 days prior to the eve,nt. Sh le us servfce w�H be O <br /> Will this be a Parade of Homes, Re�od�e�rm S aowc.as�no me�or othe Display Home? Yes <br /> /�yes,a sp�i�event perm'd is required with Po! P itted events wiN not be allowed. <br /> required unless applicant demonstrates sufficieM on-site Park+n9+s available• Non-P�m <br /> CONTRACTOR I APPLICANT INFORMATION: � „�+�.,.,n:,tR 3 31 1PN. <br /> Name: v�,� �,�F.[�oG��,Ac ��,o� <br /> State License# '3 'S �f�ce S • �E -50 <br /> Phone: � GI - -T SS Ci : p� ZIP: <br /> Mai{ing Address: lo qpplicarrt is: orrtr'a�tor' / Hom�wn�' t��"�O� � <br /> �_� A. wG��/'� �2 <br /> Contact Person: <br /> Email andla Fax: ' <br /> PROPERTY OWNER INFORAAATION: <br /> Name: � <br /> Phone(dayj: q52 ���—'$082" Ci : �Ja ZIP: S�� <br /> Address: 1 S S � <br /> Email and/or Fax (l.O� <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: <br /> Phone(day}: C� : ZMP: <br /> Address: <br /> Email andlor Fax: <br /> p,,� � o �0�� <br /> PROJECT tNFORMAT{ON: Descti ion of ro'ect: SEUt� 3.Structure Type 4.sewa9e Disposal8� <br /> 1.Type of Project <br /> 2.Proposed Use Water Supply <br /> `�Single Family with ❑Accesg°�Y B�dg.I Garage �Pu��Sewer <br /> �New Construction a�ached ga�ge ❑Deck <br /> Addition � Single Family with ����COm��e� ❑Private Sewe� <br /> ❑qccessory Building de�ached garage esidence <br /> ❑ Relocation �Multiple Family/Condo Retaining Wall(s) �Pub��water <br /> ❑Other.(specify) �public 4-feet or greater <br /> ire ❑Corrnr►erciaf ❑Storage �Private WeR <br /> *'My earth movemer►t may requ �lndustriai ❑Warehouse <br /> MCVYD review&permits. Mcw�} ❑Other.(specify) ❑Other(speaiY) <br /> Minr�haha Creek Watecshed District( <br /> 1532(?Mi�u�etcx�ka Blvd <br /> Minnetonka,MN 55345 <br /> Phate: 952�71-0590 <br /> Fa�c 9521t7t-0682 <br /> .min ehahaaeek. r � <br /> S ��07�i.O0 <br /> Estimated Construction Valuation(excluding land) <br /> P�Cet tast Updated: January 2015 p�20 <br />