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City of Orono ,1 " ---) <br /> *A 566 <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: )-)01-7-C)/ 0 � <br /> PO Box 66 <br /> (€4 Crystal Bay, MN 55323-0066 Date received: j, % -29-)1 <br /> Street Address:' Received by: L-. yUy ' 2750 Kelley Parkway Plan review fee: �' Gc` Orono, MN 55356 �' o '��.kfsHo - Main: 952-249-4600 Total Fee:l- <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 submi ted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ` <br /> Job Site Address: 160 C(/7 LO)i L-..dl-E, p-n ) Ct o N C' <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 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/ - <br /> APPLICANT, INFORMATION: /Ir Name: /fOV �1..k VIOW )e (C-/ .1)e (C-/ .1 Fl ia <br /> State License# Expiration Date: <br /> Phone: (cell) 2.' 2. . a 3 (office) e' ."/ ) 2-O j - 3Cz, <br /> Mailing Address: . 391 L.,0-r- K4 t pp Cit L� ZIP: t51 Z-0Contact Person: } F((_[Zp)v Applicant is: ontractor j) Homeowner (Circle One) <br /> Email and/or Fax: 1210.A.Lecvki 4..13 ' all--E.&i 4S-(-/ FJ> <br /> ,C <br /> PROPERTY OWNER INFORMATION: <br /> Name: LAct. Le, -4--1-Ri fIt-s LITS t) <br /> Phone (day): ( Z I - C/ <br /> Address: A O D1,17 L.c“ L -e- D City: Q?Na ZIP: 151- / <br /> Email and/or Fax ra_;vlo e 9ki-SQ-�tr' ra_ D.,pa(csyvl <br /> ARCHITECT/ 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 titSingle Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> 05elocationdetached garage 0 Residence 111 Private Sewer <br /> AV-Other: (specify) G -ND50--4 ❑ Multiple Family/Condo 0 Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial 0 Storage <br /> MCWD review&permits. ❑ Industrial ❑Vyarehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ther(s•ecify) <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) $ D ��s <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />