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41411 <br /> City of Orono �'� <br /> ii <br /> Building Permit Application <br /> it/W%r <br /> cl? <br /> for New Structures or Additionsft/kit <br /> Mailing Address: r <br /> n O A TO Permit number: <br /> V PO Box 66 (}'fJr"'0d- ' <br /> Crystal Bay, MN 55323-0066 Date received: L( —'1—15 <br /> � Street Address:' 3243 Rarpi d by �17 __� <br /> 2750 Kelley €_;: �I r 3 <br /> y y Plan review 2 1 S Z 9.0 <br /> C� Orono, MN 55356 �' <br /> �44ESH04'v Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required informfion must be submitted. <br /> Incomplete applications will be returned. (Pleats print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: Z {-1- I I Q r0 fl p l' O $5356 Lo+ ; Al0`t`1 d)'°f <br /> 33a ��rver- l � �+�t� <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/APPLICANT INFORMATION: <br /> Name: 6o(401A �a me s (?oAS7-rra pips' , 1N e.- <br /> State <br /> State License# (3C .5-3/ q6/ Expiration Date: '- 2_01,7 <br /> Phone: (cell) / Z w->g 3 2 4 7 (office) 7 /0 3 t 7 9/ 3/17 <br /> Mailing Address: fro goy. 30 b City: /,e P(At r, ZIP: s—S3S9 <br /> Contact Person: t .)/ f( gcte c-k- Applicant is: 6; TractQD / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER F•R 'TION: <br /> Name: , /4, c'P_rrt,e-e ►A-)C2(IOr\ <br /> Phone (day): 6o /2 - co 3 G-- le—Z. ` p <br /> Address: /r/(,,`3 Y- 2/"7r� /fez- N City: ( C.yxoa7./ ZIP: 5sw7 <br /> Email and/or Fax -Ajr�cs,-.-/e co.-c.4-r-: dvE <br /> t <br /> ARCHITECT/ENGINEER INFO ATION: <br /> Name: art 3/ vt i1 c-fl <br /> Phone (day): 65/- 3 - 1't 7g <br /> Address: -2_2__b y rile- 5---1-1-eey £ Sli rbc j City:.9-11 d-er Mit/ZIP: 31-0 C-2_ <br /> Email and/or Fax: gn £.o,1 bre.n A era ra,.r tec+c .cdvv, <br /> PROJECT INFORM7fION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> , New Constructio la Single Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck 10 Public Sewer <br /> ❑Accessory Bu' ing 0 Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage Residence 0 Private Sewer <br /> 0 Other:(sp ify) 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse El Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n n e h a h a cree k.o rq <br /> Estimated Construction Valuation (excluding land) $ it-53D) Q90 <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />