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Cit of Orono � Z� <br /> y ��- �g <br /> Building Permit Application / <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � � ` �� <br /> �A,. PO Box 66 <br /> � `v0 Crystal Bay, MN 55323-0066 Date received: — <br /> Street Address:� Received by: <br /> 2750 Kelle Parkwa <br /> ti�, � y y Plan review fee: <br /> c,` Orono, MN 55356 ��, �� <br /> `q'�fSHO�� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 v�v✓�n.ci oronu.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: C� ? �� ,�v�.� ,���� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Council approva160 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 INFORMATION: � � � <br /> Name: fi(.�, j �fi fi �u�' <br /> State License# �„ (�, ��/ S}a Expiration Date: �,,.�,■� _�%�;/i� <br /> Phone: cell ��• � _ � � p _ �cf � office �j ,4 <br /> Mailing Address: C Cit :'yyj • IP: — <br /> Contact Person: � � Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: '7t�,3- -z� 7 y- (p [ !t� �3 /-/�k" ��-`�'� <br /> PROPERTY OWNER INFORMATION: , <br /> Name: . !L ��. � v � N � � � <br /> Phone (day): ,2 - 7 - 3' �3 <br /> Address: ;3 $D O S l o � � � Il� Cit :� O�(it/ ?� ZIP:sS 3� � <br /> Email and/or Fax /�// � <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage �Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) G, ❑ 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 <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreeh or <br /> ` . c�� <br /> Estimated Construction Valuation (excluding land) $ 6 v� ��� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />