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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> L Mailing Address: Permit number: /7-0I IS-3 0 <br /> ® PO Box 66 <br /> f VkJ r • (. Crystal Bay, MN 55323-0066 I,�..- Date received: j /2!,//'7 <br /> 11 ry Street Address:' C1 11' Received by: i', <br /> y� ,� \ \ssV 2750 Kelley Parkway �i Plan review fee: $ alft'i,4,, 5-7 <br /> R c? Orono, MN 55356 X017_�f S 7 <br /> t�kFSHO lid 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) L5'�r1:1�,J pc ��271/7 <br /> GENERAL INFORMATION: ca47-0lli67— <br /> Job Site Address: `2�-j \CulA v\ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 9-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 /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA ION: <br /> Name: 41.k'\s\-oV'�� O\JJk-rC-.Ckt vc \*.)0t.k \--(A-2-- <br /> State <br /> (\ —2-- <br /> State License# 0_ `," P Expiration Date: '?tel '17, <br /> Phone: (cell (s(Z-C Lk—Z.SSk-e (office) , —3-12.0 <br /> Mailing Address: ' 1 yr . G j! it : ^\ 4.w ZIP: J`JL� <br /> Contact Person: ' ! Z Applicant is: ontracto ' / Homeowner (Circle One) <br /> Email and/or Fax: iAW' • :�41.4 LA . , • `"1.- <br /> PROPERTY OWNER INFORMATION: <br /> Name: V..1\ c kA,CVJ"\kk <br /> Phone(day): l4 1i`b\'L blj2j <br /> Address: I City: ZIP: <br /> Email and/or Fax tOmtx4ktt wve,4-\Sccur�t_CC xvAAA.COwk--- <br /> ARCHITECT/ENGINE INFORMATION: J 1 <br /> Name: rG \---•—�i��,(�. V " <br /> Phone(day): - , �. \ "' <br /> Address: 1...\ Pr ' VA., City:,,N\y'>>AV ZIP: J C <br /> Email and/or Fax: -MU . -" ' vNe\\ ,64,\,(S)w'' <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> AT New Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage [' Deck ❑ Public Sewer <br /> LI Accessory Building ❑ Single Family withOffice/Commercial <br /> El Relocation detached garage .Residence ❑ Private Sewer <br /> ❑Other:(specify) LI 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&permits. ❑ Industrial ❑Warehouse 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑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.oro <br /> CL <br /> Estimated Construction Valuation (excluding land) $ SV-71I Zii. <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />