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Y r <br /> City of Orono 742\ ' <br /> � <br /> Building Permit Application <br /> for New Structures or Additions _ <br /> Mailing Address: <br /> ig �} PO Box 66 Permit number: 2L'0-, --64 f <br /> -I j�� l Crystal Bay, MN 55323-0066 Date received: 9/2 (-f f(, <br /> �` Street Address:' l � '0� eceived by: <br /> -% It 2750 Kelley Parkway <br /> a , Plan review fee: P , 7 j <br /> L \0 Orono, MN 55356 / CL' <br /> '�kEsHO- Main: 952-249-4600 —'f�otal 1-t'e7 <br /> Fax: 952-249-4616 www.ci.orono.mn.us 5`5(X(/4/ Da✓ <br /> This application form must be completed in full and all required information must be submifted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �,`� � I,, �P�'n .Jj� ��� <br /> Job Site Address: yVJ d�1�14r'- &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 Ne <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP,L��T INFORMATION:�� <br /> Name: .f< <br /> State License# C J ' a' Expiration Date: 3/- /2' <br /> Phone: (cell) (o / ) - I - ,• (office) 95',2 - ` - 'ss- <br /> Mailing Address: _� S s L;„ L ed Cit : e / 4,ery ZIP: �< Sj <br /> Contact Person: �J P � ei, Applicant is: ontrac or / Homeowner (circle one) <br /> Email and/or Fax: ,j ;C;,,,jeh C) K,,,,Cl he,,.vies ,l 0441 <br /> PROPERTY OWNER FORMATION: <br /> Name: 1-44r-k. f0 uihur^ <br /> Phone (day): 4 .1 - 7.0A •-g G,'S <br /> Address: �/ g ,/ // :"L'A I Z-4 7 p City:C�Cefs/A- ZIP:53:7)2/ <br /> Email and/or Fax p/n N //!c'r¢,., �j. /,.9,Y - C #11 <br /> ARCHITECT/ ENGINEER IJJFORMATION: <br /> Name: //e2/6"a�-� <br /> Phone(day): 765 7/ 7 'v <br /> Address: 9 / bo ` ,� //;.,0.--r ,L i7 City: /3/4,4e ZIP:' <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 1 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ANew Construction Single Family with 11 Accessory Bldg./Garage <br /> ddition attached garage [' Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation detached garage Residence Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo Retaining Retaining Wall(s) <br /> El Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial 11Warehouse 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.orq <br /> Estimated Construction Valuation (excluding land) $ 6 5-6)000 00 <br /> Packet Last Updated: August 2015 <br />