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City of Orono <br /> Building Permit Application <br /> � for New Structures or Additions <br /> ' Mailing Address: permit number. '� � � <br /> QA. PO Box 66 <br /> � `wQ Crystal Bay,MN 55323-0066 Date received: � <br /> Street Address:' ' <br /> y ,� 2750 Ke�ley Parkway n:11�� � ��f�: s'v"1 , <br /> '" c? Orono,MN 55356 L V► VV <br /> ��'rESH�Q'� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application fortn must be completed in full and all required infortnation'must be submitted. <br /> lncomplete appUcatlons will be retumed. (P/ease print) <br /> GENERAL INFORMATION: ,!� <br /> Job Site Address: �_QR��� �jl{ �-+(' <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes No <br /> N yos,a specie/evenl permit is requ�ed with Police Department and City Council approve/80 days priw to the event. Shuftle bus service wdl be <br /> requi�ed unless appliceM demonstrates su/Ficient on-sife perkirg is available. Non-permitted events wAI rrot be allowed. <br /> CONTRACTOR/APPLICANT INFORMATI�Of� <br /> Name: �'i)e(`c�tya tH!'j/yleS �.'N� <br /> State License# QCap�5�'7 Expiration Date: —3J�-/�e <br /> Phone: cell office p� � <br /> Mailing Address: �(QoS CavhOu t f�[" City ^ti.r�rxa�4� p• yt� <br /> Contact Person: rv� � Applicant is: / Homeowner �a.d.on.� <br /> Email and/or Fax: �}^�� �p /�J[�r� �Ps C,,,,,,,,, <br /> PROPERTY OWNER I ORMATION: <br /> Name: �i`� ��rL�r . <br /> Phone(day): _ ^- pp <br /> Address: '?oS viG,� _ _ Citv:�v�/ � ZIp• �� <br /> Email and/or Fax "+' <br /> ARCHITECT/ENGINEER INFO MATION: <br /> Name: S � <br /> Phone(day): _ / <br /> Address: � r� Cit :�l n,1�_ ZIP: " `T <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: -'�-LV <br /> 1.Type of Project 2.Proposed Use 3.Structure 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 defached garage ❑Residence <br /> ❑Private Sewer <br /> ❑Other.(specify) ❑Multiple Family/Condo ❑Retaining Wall(s) <br /> O Public 4-feet or greater (�Public Water <br /> "Any eaRh movement may require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑p�er.(specity) ❑Other(specify) <br /> 15320 b6nnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phane: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.min h h r k r <br /> a � <br /> Estimated Construction Valuation(excluding land) Q <br /> Packet Last Updafed:January 2015 <br /> Page 20 <br /> �. �. �� �, u� h� v� �_ �� (� <br /> (��'1 G C� <br /> '' C C� <br /> / <br />