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City of Orono <br /> Building Permit Application , -, <br /> for New Structures or Additions / l <br /> Mailing Address: Permit number: AN 8--Ot)/9i-/ <br /> 7.-v..Q AA,, PO Box 66 • <br /> 'YO Crystal Bay, MN 55323-0066 p (J Date received: gStreetAddress:' <br /> 41Y1�J Received by: 6. i �j <br /> 4'.. 2750 Kelley Parkway <br /> yF iOrono, MN 55356 Plan review fee: /q Q fit <br /> el <br /> '��"fsri�R Main: 952-249-4600 Total Fee: (J " <br /> Fax: 952-249-4616 www.ci.orono.mn.us W I c ' 2- <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: , -',0C) {132P v_e'r[5 TO,,.,— P-6 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 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: Vii!%LCL.( �S• t .A5 �. (...c__ <br /> State License# ,(C'0 !5—. (.2 Expiration Date: •j (, (t; <br /> Phone: (cell) 4212 - Z-_t -raj-( 2.., (office) (;,t2-.. SL7.-14S <br /> Mailing Address: 4;2024,, ru.S.Sue..—? (�;. `> City: l'(, .. -> ZIP: '-1 C7 <br /> Contact Person: D(>r4 F 12 &4-Q Applicant is: .Contra` .. / Homeowner (Circle One) <br /> Email and/or Fax: >r- (J i,i 0L[y r - -- -' . (Cy-1 <br /> PROPERTY OWNER INFORIYIATI <br /> Name: 1-49-vLL. Gc,Q.(/1J74 tl t----_— <br /> Phone (day): (p c~/ gl Z Z <br /> Address: / -t9b 1 C -!i, ' ?/';� City: ,t ZIP:`3 <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: 01 k_t J-1-, 4./2 G—) _ <br /> Phone (day): (.j( 7 j5 12_.1 C <br /> Address: City: P1 Pt-3 ZIP: <br /> Email and/or Fax: )„,„.{,,, (2.F:0.4 wrr11'V t -'t)..-; (_c.a'7 <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 IN Single Family with ❑Accessory Bldg./Garage <br /> illklit Addition attached garage ❑ Deck Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage gResidence ❑ Private Sewer <br /> El Other: (specify) El 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 [.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.org ,Ir �� � CE' D <br /> t® <br /> Estimated Construction Valuation (excluding land) $ � / (119'(' FEB P 3 2118 <br /> Packet Last Updated: August 2015 CITY OF ORONO <br /> Page 21 <br />