Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: (, �/'� <br /> QA, PO Box 66 f 4-, <br /> �*c. <br /> Crystal Bay, MN 55323-0066 COate received: -p� �� <br /> Street Address:' "� Received by: <br /> y2750 Kelley Parkway Plan review fee: 4t / T 7i 7S <br /> Orono, MN 55356 _ <br /> kFSHO1' Main: 952-249-4600 Total Fee: � " ��7 <br /> Fax: 952-249-4616 www.ci.orono.mn.us �J�J(}4,, J <br /> This application form must be completed in full and all required information mus a submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 5&S O c k ekrd -P 1-L- g.oJ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 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: T` t- rrv\C—kit.. <br /> State License# (gys Expiration Date: 63l 2d 1 <br /> Phone: (cell)6,12,77--z5--7 mei (office) 70-7 -O-2q'1q <br /> Mailing Address: 9/nO cw,a, c_ gir. hE & -- tot Cit : (az,,,` ZIP: c.,5yyy <br /> Contact Person: iorx fLa,,.,cy Applicant is: Con ra / Homeowner (Circle One) <br /> Email and/or Fax: / JonQ-0hl-,,smt5,Caryl <br /> PROPERTY OWNER INFORMATION: II <br /> Name: iM:K e, -F r m n a.a&le <br /> Phone(day): <br /> Address: J&S Of • po‘i City:Orrnp ZIP: <br /> Email and/or Fax m in a 1 I cA SLI C 10 Cal Qtwti I•LQ Y►'1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): Q76 .2 / a <br /> Address: j <br /> Email and/or Fax: /q lq'. gi <br /> PROJECT INFORMATION: Description of project: `` <br /> 1.Type of Project 2.Proposed Use L 1/, & <br /> New Construction Ef Single Family with <br /> ❑Addition attached garage Id <br /> ❑Accessory Building ❑ Single Family with // / <br /> 1119 arae �/ / <br /> Relocation detached <br /> ❑Other:(specify) ❑ /Multiple Family/Condo � �i �'r'�J I' II <br /> ❑ Public /— <br /> **Any earth movement may require ❑Commercial <br /> MCWD review&permits. 0 Industrial <br /> Minnehaha Creek Watershed District(MCWD) El Other: (specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ /O®I WO• <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />