Laserfiche WebLink
��,•� ��,,o� City of Orono <br /> �� ��`'`� Buildin PermitA li i <br /> o�„� g pp cat on <br /> �i for New Structures or Additions <br /> Mailing Address: Permit number: Z o((F.. --L�� , /3 <br /> � PO Box 66 <br /> � �Q Crystal Bay, MN 55323-0066 Date received: 3 3 / (o <br /> Street Address:' � I"'`� <br /> y ,� 2750 Kelley Parkway �C(�, —D�'�-�� <br /> �. � `� �� Plan rev�ew fee: �• `7 <br /> �� �� Orono, MN 55356 r � � �,Q <br /> kESHo� Main: 952-249-4600 Total Fee: � <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 print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� �jC� �Cy�;�, p� �,y�y , rn� ����� t <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er Display Home? ❑Yes No <br /> If 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 /> requiied unless applicant demonstrates su�cient on-site parking is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �U:v� �'S'c�vV�yti �.CS ti1��.�-t�C��� �'�1G. <br /> State License# ��{�t-�� Expiration Date: �� ;� �� � <br /> Phone: cell 1 . 'Z � , �Q�� office --- <br /> Mailing Address: '°')� � � � Cit :'tu�.� ��r;� <br /> Contact Person: ; vr.y�. Applicant is: Contractor / Ofll@OW . (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNE�R,�N�ORMATION: y , <br /> Name: if►�+G��� � ts�� '�S�-t <br /> Phone (day): . tSCX� . '��' `v . f _ <br /> Address: .�".�1'3 � Ci � �,�,�� z�p: �yt'�7 <br /> Email and/or Fax �c tr�� v� ��„ �y� �v� p �,�p`y� <br /> ARCHITECT/ENG EER INFORMA ON: , <br /> Name: ;�,�( � �P �' c�' �0. � <br /> Phone(day): �Z• 'Z, � j <br /> Address: '� as� G Ci :� 1 '��'� ZIP�� � <br /> Email and/or Fax: u��L�, ;,�� � ` ,���} � .`�y <br /> PROJECT INFORMATION: Descri tion of ro�ect: � •.. `r� �L� ' �ry� �,.` �,L <br /> 1.Type of Project 2.Proposed Use 3.Structure Ty 4.Sewage Di osal 8� <br /> ��� Water Supply <br /> �New Construction ��� �(Single Family with <br /> ❑Addition attached garage ❑Deck � Public Sewer <br /> ' ` ❑ ❑Office/Commercial <br /> Relocation Residence <br /> ❑ Other: (specify) ultip e Fami y Condo �Retaining Wall(s) � Private Sewer <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8�permits. Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ther: (S eCi ) ❑Oth2r(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �j� ��;'j ✓^ <br /> � ' <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />