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City of Orono 9)p <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: &/J6'—Q/3 ',P <br /> ^� PPO Box 66 Permit number: <br /> / <br /> 7-i...--0 -4 PO <br /> Crystal Bay, MN 55323-0066 Date received: /0'3d"l-� <br /> Street Address:' aN / Received by: ��1 C� <br /> /). <br /> (\' '( <br /> 2750 Kelley Parkway 1 goLs_0/ 7 <br /> +'' I Plan review fee:Orono, MN 55356rrMain: 952-249-4600 c Iq5•�� <br /> 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 a ,2licatinns will be returned. (Please print) <br /> GENERAL INFORMATION: (�W ll <br /> Job Site Address: \AO kYd Ofc)nc r\ `()ca A S <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? E 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: KR or Flans es" <br /> State License# 1C (ato>>'Sy Expiration Date: ?/3, / b,7 <br /> Phone: (cell) (a i s - (850 - S a(90 (office) S d r1)e... <br /> MailingAddress: _1(90 &in, '/4te IJorr4h Cit : M(3. ZIP: 55311 <br /> Contact Person: TEpp D'A rio Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: OZAR JCOtJ (A44101.st• hie,- 1c - „Xi-.ai0: <br /> PROPERTY OWNER INFORMATION: <br /> Name: t�,ohgu alvAielk USW NEL ' LIC <br /> Phone(day): lP t 7,--.ai - q'/0 E' <br /> Address: City:- Li '%11..k ZIP: <br /> Email and/or Fax ; brufliJ( \low°-OWL <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Jah.ki &-tit41 .fid '<Artful <br /> Phone(day): 'Its, 3— 360 3 S'6 <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 /> El New Construction Single Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck E.T Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage [Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require 0 Commercial ❑ Storage <br /> MCWD review&permits. 0 Industrial ❑Warehouse ❑ 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 I <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />