Laserfiche WebLink
Cit of Orono a 3:1) <br /> BuildingPermit A licati�n I <br /> pp J <br /> for New Structures or Additions <br /> Mailing Address:IcL � ) _ �_ <br /> Q PO Box 66 Permit number: /U i u' Dc-)`w0Crystal Bay,MN 55323-0066Date received: ii 4 <br /> Street Address:' Received by: _ <br /> a � 2750 Kelley Parkway <br /> S review fee: <br /> F tea <br /> C Orono, MN 556 Q`(o -(j0/� _ <br /> iktsHol Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us b (4 ) <br /> This application form must be completed in full and all required information must be subm ted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �(� 7orc... ce-ck :kr--k___ <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: MS L C ,sem.., rt.eS . 1---L-C-- <br /> State <br /> -L-QState License# ;3 Q. 6,3 4 72 h Expiration Date: 3f 3///7 <br /> Phone: (cell) 4s' 450-7 S S 5 (office) (Q/1. e6>, 5 SS <br /> Mailing Address: i Si o i ,,,e 4 c>e``Q (^ o City: S ZIP: S3q/ <br /> Contact Person: Oa,,‘ Mu (r-en itchitche-N Applicant is: ontrac r / Homeowner (Circle One) <br /> Email and/or Fax: ivtd l r- .n r►Q n Ci in S ; c V 5 4- - .In evil e S, c o ,rN <br /> PROPERTY OWNER INFORMATION: <br /> Name: —4e/. 3 O.n ((4 /00-4-4-.; <br /> Phone (day): _.Lfti: 4,11. •24,3 • L./53 <br /> Address: 2vq,o We--4:4-07 Q Q . City: Oh5-../L.0 ZIP: 5535 <br /> Email and/or Fax •ow. toy eq.,- , c--._ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 5kartQ1{- .1)e5: i Wtnz.e (Eniieel-... . 11L . ? Z-• Srde•6516 <br /> Phone(day): qS2 . K>o• f17- <br /> Address: ‘-(6g/ +i e.e, - 5,,.'IP /oo City: C-5c.ce(S,o.r— ZIP: 55 33 <br /> Email and/or Fax: ;, .-o a sii,a..t-r,c #-.Co5.3,..., , G c9w� <br /> PROJECT INFORMATION: Description of project: /1,l'--e r /c5 _, _ <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ( -New Construction ®.Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 2 Private Sewer <br /> El Other:(specify) ❑ Multiple Family/Condo Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse R Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) /q <br /> EV 06'0 RECEIVED <br /> Packet Last Updated: August 2015 FEB 0 5 ?016 <br /> Page 21 <br /> CITY OF ORONO <br />