Laserfiche WebLink
LtCity of Orono ') <br /> sm <br /> . . <br /> . .• <br /> Building Permit Application4 ie)5 <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �I iv—CO�la 9 <br /> Q PO Box 66 <br /> f v0 ' \0 Crystal Bay, MN 55323-0066 Date received: 0? is I to <br /> - ` Street Address: w v i sea_ Received by: <br /> S <br /> t) 2750 Kelley Parkway O((o-Qpcj'7D Plan review fee: 2 yS9 . <br /> Y <br /> c` \f\ <br /> „� Orono, MN 55356 / _ <br /> l44-EsH0-� v 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: - 1 1 �O � � N <br /> Job Site Address: S 70 01-0.00 �'(t <br /> o.4x kr ct.� O'row <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes E No vat <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: K R v HOl'hPzS- <br /> State License# i3 (,(,3�Sy Expiration Date: W3//'070/7 <br /> Phone: (cell) (pi .- y -5alou (office) _54fyi e. <br /> Mailing Address: 6,610 Qv Pa-' - /km. City:MA.0e, Gni ZIP: Ss..?// <br /> Contact Person: - , 40 Applicant is: ontrac or / Homeowner (circle one) <br /> Email and/or Fax: JJicfr:;Cot./ 0 CO AST. mut- <br /> PROPERTY OWNER INFORMATION: <br /> Name: SIEPf JR& 4— To RN 5.1W.UEct0 )4 C� I <br /> Phone (day): (0 l 3 -4.S1, -S--- a crw �Qu We i' 4 <br /> Address: Ito B' O cap i'• rtx.Le /OCR rH / l' <br /> Email and/or Fax iTJ KRJCON ecc►Mc r r .NET hi <br /> %� <br /> ARCHITECT/ ENGINEER INFORMATION: IP IIDIAjdzie--A__) <br /> Name: kt) <br /> l'i rifi;wd D-(-Z: - <br /> Phone (day): -pg 6-4, ( (4a) <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use ;al& <br /> Er New Construction 'ingle Family with <br /> ❑Addition attached garage <br /> ❑Accessory Building 0 Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 Private Sewer <br /> ❑ Other: (specify) 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> ❑ Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require 0 Commercial 0 Storage ,� / <br /> MCWD review&permits. 0 Industrial 0 Warehouse l2'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) $ 53 8i 000 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />