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� , . <br /> City of Orono <br /> ��: Building Permit Application <br /> �� \'° for New Structures or Additions <br /> ,� <br /> Mailing Address: ��/� �DD7 <br /> ;'"���_� PO Box 66 Permit number: <br /> ' � �Q��, Crystal Bay, MN 55323-0066 Date received: �� ��l.� <br /> j � Received b : <br /> Street Address:� Y �� <br /> � ' ' 2750 Kelley Parkway � /�Q �� <br /> .� � � Plan review fee: <br /> c, Orono, MN 55356 --�------ <br /> t"�krsr+o��' Main: 952-249-4600 Total Fee: �l�/�p-dd07 <br /> �--s` 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: �j ���(i � -� � �'� S I��•.� � /� , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf yes,a special event permit is required with Police Deparlment and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '�`%�j� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor ! Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORM�,TION: <br /> J <br /> , <br /> Name: ' J �� �_�:��4��_ �%�� �..-��a�, ;� <br /> Phone (day): � � Z 75��/ --71 �`l <br /> Address: 7-� 7 5 /�l � I;�z n�1 City: �',���;>�rk�:-.c-c ZIP: S �3 S'�� <br /> Email andlor Fax i.r,s ; �i ; �. h����,-t} c� G�,.,.�n; I < �- -w <br /> ARCHITECT/ENGINEER INFORMATI N: ' <br /> Name: ��� �,� �� <br /> Phone(day): � ��� L��� <br /> Address: C�J� �� <br /> Email and/or Fax: ' 1'r' <br /> PROJECT INFORMATION: Descri tion of ro'ect: fi� � <br /> 1.Type of Project 2.Proposed Use 3.Struct iisposal& <br /> pp ly <br /> ❑ New Construction �Single Family with ❑Acces <br /> ❑Addition attached garage ❑ Deck �uer <br /> ❑Accessory Building ❑ Single Family with ❑Officeicommercial <br /> ❑ Relocation � \ detached garage ❑ Residence ❑ Private Sewer <br /> .�ther: (specify) I � �r.\ ❑ Multiple Family/Condo ❑ Retaining Wall(s) <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) ❑ Other: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd �1�� � <br /> Minnetonka,MN 55345 � <br /> Phone: 952-471-0590 � '� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ����-� � �l_� C� - ��' <br /> Packet Last Updafed: August 2015 <br /> Page 21 <br />