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t . � <br /> . �3 <br /> City of Orono � � � <br /> . . . . . p� � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � ' �S <br /> �Q A TO PO Box 66 <br /> !w Crystal Bay, MN 55323- Date received: �" — s <br /> StreetAddress:' ��� Received by: <br /> � � ,� 2750 Kelley Parkway � � D`S f' 0�� <br /> y�' c? Orono, MN 55356 �� Plan reviewfee: . <br /> t�KESH04` Main: 952-259�600 To e� <br /> Fax: 952-249-4616 www.ci.orono.mn.us � • <br /> This application form mu�t be completed in fufl and all r�equired iriformati must be submitt <br /> Incomplste applicatlons will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3 �js VE O SS3°1� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe Display Home? Yes ❑ No <br /> /iyes,a specia/event permit is required with Police Department and City Council approva!60 days prior to the event. Shu !e us service will be <br /> required unless applicant demonstrates su(ficient on-site parking is availab/e. Nan-permitted events wifl not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ECmG��c <br /> State License# ��'3�g�3 Expiration Date: 3 $� Zo16 <br /> Phone: �cell) (,12-9�.8 -7655 (office) qS�-59�f -5037 <br /> Mailing Address: Ip Ci : A ZIP: <br /> Contact Person: �� �p��eq Applicant is: Contractor / Homeowner �ci�o�� <br /> Email and/or Fax: �g�,`�� pES�(,�J p,y���.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �k(Gt,op� � �W{ Mp,Q.x <br /> Phone(day): qSZ -25D-$0$2 <br /> Address: �135 t•b(r.t17k Sti�oR� ORE��. City: t�o1� ZIP: �S3F11 <br /> Email and/o�Fax rV►(�,pp�N►pp��Mp►t,.GoM <br /> ARCHITECT/ENGIIdEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORAAATION: Descri ion af ro'ect: SBC+oe�D � r� /►•�D t o ��- <br /> 1.Type of Project 2.Proposed Use 3.3tructure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �'Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck ,�Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage esidence ❑ Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo Retaining Wall(s) <br /> ❑ Public 4-feet or greater �Public Water <br /> *'My earth movement may require ❑Comrr�ercial ❑Storage <br /> MCWD rev�r 8 permits. ❑ Industrial ❑Warehouse ,�Private WeN <br /> Minnehaha Creek Watershed Dstrict(MCWD) �Ot�ter(speCify) ❑Other(speCify) <br /> 1532Q Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-06$2 <br /> www.minnehahaaeek.or <br /> Estimated Construction Valuation(excluding land) $ ��,O?`.� <br /> Packet tast Updated: January 2015 <br /> Page 20 <br />