Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �/ -cl 3[l I <br /> QAA,> PO Box 66 Permit number: ` <br /> `w0 Crystal Bay, MN 55323-0066 ;1 R� Date received: /0:I:II <br /> I <br /> l� Received by: <br /> StreetAddress:' 4 <br /> 2750 Kelle Parkwa <br /> s. Y Y t Plan review fee: 14.41 g0,2 X) <br /> c? Orono,MN 55356 <br /> �`ikESHo --t Main: 952-249-4600 Total Fee: oft��t <br /> Fax: 952-249-4616 www.ci.orono.mn.us .SCYOW um** red, <br /> � <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: /116r4 / <br /> Job Site Address: 70Oo festa_ c <br /> G � <br /> Gi <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? ❑Yes J71'Jo <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 /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP CANT INFOR ATION: <br /> Name: ‘,.,1-,State License# alibi� l/J;� Expiration Date: <br /> Phone: (cell ,k7. "' D - i - - (office) ' -SOS/- �� <br /> Mailing Address: Z __ _ '/�J, ,. L 0 - (�.- Ci 1(i ZA4Gc._ ZIP: 39 1 <br /> Contact Person: l I Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: g f11-eiseh eti., 1-1 _14 de t norrteS • cdm <br /> PROPERTY OWNS NFORMATION:_ , <br /> Name: �x�'1 M c©' 4 t`�G!'�e-(.L•e- ,ca-ba to <br /> Phone(day): <br /> es?: 3f6 0 MA,- ' , e Cityl. /2/044-4 ZIP: b�514fZ! <br /> /Email end/or Fax r y -q, Mai pn r p Jp i per( • coo, a <br /> ARCHITECT/ENG! R INF• -MATION: �.y� / <br /> Name: �f-Zo-�jieo/'ia/r/lS"�'63 <br /> Phone(day): 2 Z c% <br /> Address: 2Cf `yr • >C CL/ ,- ZIP:56-oeL <br /> Email and/or Fax: D1?0 C'C?11bl'Pa't/1pr^ kC4me:IS • corn <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> _/ Water Supply <br /> 12 New Construction i2rSingle Family with El Accessory Bldg./Garage <br /> El Addition attached garage El Deck El Public Sewer <br /> El Accessory Building ❑ Single Family with ❑Office/Commercial <br /> El Relocation detached garage 21-Residence 1290.rivate Sewer <br /> El Other:(specify) El Multiple Family/Condo El Retaining Wall(s) <br /> ❑Public 4-feet or greater El Public Water <br /> **Any earth movement may require El Commercial El Storage <br /> MCWD review&permits. El Industrial El Warehouse Private Well <br /> Minnehaha Creek Watershed District(MCWD) El Other:(specify) ['Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ 06 CVO <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />