Laserfiche WebLink
, <br /> City of Orono -)11- el <br /> ., r <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: <br /> Box 66 <br /> Permit number: .v/S-c t k).."5 <br /> �O�Q Crystal Bay, MN 55323-0066 Date received: 1 .-7R3,-/7 <br /> Street Address:' Received by: i % <br /> y 4' 2750 Kelley Parkway ��\�r4 Plan review fee: 15 09 C). CO <br /> F �` Orono, MN 55356 <br /> !'lkEsH00. Main: 952-249-4600 Total Fee: (`.1 .--'6100 7(p <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: 33a5 (14-4 5t 1 ig.: go, <br /> Will this be a Parade of Homes, Remodelers Showcase He or other 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 /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: odd 0).0,1 <br /> State License# Expiration Date: <br /> Phone: (cell) (.-S i) 2?'S- e is-/ (office) <br /> Mailing Address: "33Z C,rgst./ Z4;44 ,J City: CJrc,u. ZIP: Ss-3W7 <br /> Contact Person: ' /J Applicant is: Contractor / omeow r (Circle One) <br /> Email and/or Fax: feiIa/y e ,E,f-ya/),,,;,;,, <br /> PROPERTY OWNER INFO,FMATION: <br /> Name: —hal 0I s4.-✓ <br /> Phone (day): 65i) L',1.5`- o,c i <br /> Address: 3326 6eys-*47 os-1 Al City: ZIP: <br /> Email and/or Fax fail oI v t :It- yg ,,, c,--., <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: R A-4/ aiti 44/44 7 1 <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction <br /> © Single Family with 0 Accessory Bldg./Garage <br /> ®Addition attached garage 0 Deck <br /> Public Sewer <br /> Accessory Building 12 Single Familywith 0 Office/Commercial <br /> ❑ Relocation detached garage ® Residence 0 Septic <br /> ❑ Other: (specify) 0 Multiple Family/Condo 0 Retaining Wall(s) (Compliance certificate <br /> 0 Public 4-feet or greater may be required) <br /> "Any earth movement may require 0 Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> E Public Water <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 0 Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ VAC i 000, oo <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />