2015-00814 - new structure - Laserfiche WebLink

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1' , \ � City of Orono � �5�. S� Building Permit Application � for New Structures or Additions MailingAddress: �� • � ; (L \ PO Box 66 Permit number. j /�O�Q�� Crystal Bay,MN 55323-0066 Date received: � i � i Street Address -.—'-''- � d�':--- / __� �..___ � �� ;� 2750 Kelley Parkway � 1 �✓r IH�iew fee: , �� • � F �i Orono,MN 55356 L' ._. " � __�___.___.-�' �"�K�sHo�� Main: 952-249-4600 Total Fee: G' ,,.�( Fax: 952-249-4616 www,ci:orono.mn.us � �`�Q� � �IU�/�1I` This application form must be completed in full and al�required information must be submitted. �� Incomplete applications will be returned. (Please printJ GENERAL INFORMATION: e Job Site Address: ��Q� ��,� ��f(}f C � Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑Yes �No lf yes,a special event permit is required with Police Departmenl and Ciry Council approval 60 days pnor[o the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: �v Cr-•��✓, �r'v'k'S �/V� State License# c`vL'��5� 7 Expiration Date: -3/.-j�� Phone: cell n i Z-- 7cj�j _2y�3 (office) `7(�3 -�r�-�,U q Mailing Address: -ZL�vS e�-tvy,n� � �`�- City: 3`�I�.�,;�;,.++�. IP: `Z/y/ Contact Person: -�-�.�-� .i-��-Q y,�,� Applicant is: o�Hrac r / Homeowner �c��iao�a� Email and/or Fax: !j�v� �i /�/Prsc�.n.h�r�.vs , C'��an PROPERTY OWNER INFORMATION!: ._ � Name: C j"G�I�y �c�C 't"� Phone(daY) (i/2- .G�/G' ,��`/00 address: �� LaKr✓�fw �9-v� c�ty:%o.�.� r"�., ziP 4'�3"3/ Email and/or Fax ARCHITECT I ENGINEER INFORMATION: Name: � �• �S/'�✓ Phone(day): . - �r ..., : t --�.�` Address: �'J/p d ��,,.y�e�+ S�� 7vr� �j City:��l1/n.� ZIP: j� !T� Email and/or Fax: PROJECT INFORMATION: Description of pro ect: �r-R-Lv 7 �L 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& � Water Supply ��New Construction �Single Famity with ❑Accessory Bldg./Garage ❑Addition attached garage ❑Deck �Public Sewer ❑Accessory Building ❑ Single Family with ❑OfficelCommercial ❑Relocation detached garage ❑Residence ❑Private Sewer ❑Other:(specify) ❑Multiple Family/Condo ❑Retaining Wall(s) ❑Public 4-feet or greater �Public Water "Any eaRh movement may require ❑Commercial ❑Storage MCWD review&pertnits. ❑Industrial ❑Warehouse ❑Private Well Minnehaha Creek Watershed District(MCWD) ❑Othe�:(specify) ❑Other(specify) 15320 Minnetonka Blvd Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or $ \ t Ca Estimated Construction Valuation(excluding land) Q � Packet Last Updated: January 2015 Page 20 �' r: `�c I, � � h z 4,� �; tj`1 l , � �;� , �� .,�� ! J r .,