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City of Orono <br /> BuildingApplication 9 <br /> Permit pp D51.9,,?, <br /> for New Structures or Additions <br /> Mailing Address: ���_ 3FX <br /> �0 A PO Box 66 Permit number: Q <br /> Crystal Bay, MN 55323-0066 Date received: / '/2 /J <br /> Street Address:' Received by: 19 <br /> yF 2750 Kelley Parkwa��� Plan review fee: . 5-y3o. 7d <br /> c? Orono, MN 55356 <br /> �ikESHov-f" Main: 952-249-4600 �� j� Total Fee: ©I l COO . <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: 1180 }}oA r( PF,tJE <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Igl 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: W00DPAL.E- BO1 41zi .S \,JC. <br /> State License# $65029Z6 Expiration Date: a1311 2018 <br /> Phone: (cell) (,12.. 31Q3-3558 (ofCe)152.346-OS+3 <br /> Mailing Address: (o1)1 Blest C;rc,le pa,Ue._ sone_ 101 Cit : ,' ZIP: <br /> Contact Person: J . Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: m3uV0.upe W.._ .c, eV)uilders,.LjOp+ <br /> PROPERTY OWNER INFORMATION: <br /> Name: 5qM e.. <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: SRnne_ <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 /> XNew 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 KResidence V Private Sewer <br /> ❑ Other: (specify) Cl 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 Nr 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 RECEIVED <br /> Estimated Construction Valuation (excluding land) $ 1� Sao,opo JAN 1 Z 2018 <br /> CITY OF ORONO <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />