Laserfiche WebLink
• City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 <br /> Permit number: o - DC) /7 <br /> �o V0 Crystal Bay, MN 55323-0066 Date received: ' <br /> Street Address:' Received by: <br /> A .1.. 2750 Kelley Parkw. Plan review fee: S <br /> L Orono,MN 55356 <br /> t1'FFSHOP� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> /� <br /> Job Site Address: l''I O or-c_ - :1.4-k_ '" <br /> Will this be a Parade omes, Remodelers Showcase Home or other Display Home? El 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: x115 r Ca s419-,-,-... ild-en..es _ 1--1---c---- <br /> State <br /> .,.LQState License# Q. 6,39 72-r-7 Expiration Date: ..V3///'7 <br /> Phone: (cell) 401.1. ea,`, 5.-fS 5 (office)(p/,t• 06 7, 5 S <br /> Mailing Address: /S,o/ ,nem Q 1raep City: ZIP: 5'5 397 <br /> Contact Person: van ()tu l -Q.n n,e v, Applicant is: ontrac r / Homeowner (circle one) <br /> Email and/or Fax: Ma II.t-arl,e , 0 m.c : e4.)•s4-ewi14e,me.S . com <br /> PROPERTY OWNER INFORMATION: `, <br /> Name: _.(e,,. 4_ 0.a (( /Vo,t-tom, <br /> Phone(day): t_-: (ell- •qa23 • 3"'S3 <br /> Address: 2v4, ) We-1)6.g:—b4: (J.._% . City: D/`6. .,, ZIP: 5535/ <br /> Email and/or Fax mor, @ oo�t.e cc>1jurcCu , Ce)....,,, <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: 5 ha.rrce. ,Ae s; rc (ill rt z.2 (Enl e e t-. �/I L 1?z• e .654, <br /> Phone(day): qqz . '1)0• 4717 •1 <br /> Address: ea,cif Sece..,�Q S•l-ie,e.f- 5,,,'( 'l 3P tee City: ce(5,-*4--- ZIP: 5-5 33 <br /> Email and/or Fax: ;q e s . - - tS�„Ce S=3.� . Go-.-.--, <br /> /lj--�'C� f� <br /> PROJECT INFORMATION: Description of project: 1 / OP A <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> RN Construction ®,Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Office/Commercial <br /> ❑Relocation detached garage Residence (21 Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/CondoIL Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require ❑Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial ❑Warehouse R 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.minnehahacreek.orq <br /> N <br /> q <br /> Estimated Construction Valuation(excluding land) &. Oif,0 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />