Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> ® for New Structures or Additions <br /> �QA r RECEIVE <br /> BoxAddr66 <br /> � <br /> V Permit number: �/�—l1Ugj <br /> e4 k602Q�I Crystal Bay, MN 55323-0066 Date received: 7/7-17 <br /> JUL 17 ", <br /> 4 <br /> Street Address:' ll , Received by: <br /> fitr. r, GSA'` !cm(OF ORONO 2750 Kelley Paricwa �I i,l, <br /> t�k�sHOQ`� Orono, <br /> MN 55356 1 I��II fill Plan review fee: //D,X02 <br /> Main: 952-249-4600 Total Fee: d0/7-Z9e ' V <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 /> Job Site Address: 570 OV�"o 4Jo d rchArr( C cl <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 0 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: X.O.J.- <br /> State <br /> .O.fState License # Expiration Date: 3/3/ //ca <br /> Phone: cell - .D.- .so -S'a,o office <br /> Mailing Address: f o% 864. P/, N)oit, Cit : r l r c PT IP: C1-1// <br /> Contact Person: ,Ttfp Applicant is: Contractor / Homeowner <br /> PP (Circle One) <br /> Email and/or Fax: i/c/KINGvk e c.ofnc/}ST,^pci- <br /> PROPERTY OWNER INFORMATION: <br /> Name: TEFF ,f46L — J,81t1Nell u L L C <br /> Phone(day): Co i,2-Q,sb- sacoc.> <br /> Address: I 4,,(6 40 'do•h Place X44 City:/t9 Grp vC, ZIP: SSW( <br /> Email and/or Fax <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: .S0k.1e Ci.S cvlovti <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: _Same u.s adovt <br /> Phone(day): <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 YP 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction <br /> Single Family with 0 Accessory Bldg.I Garage <br /> ®Addition attached garage 0 Deck <br /> ❑Accessory Building 0 Single Family with 0 Office/Commercial ❑ Public Sewer <br /> ❑ Relocation detachedara e <br /> 9 9 0 Residence <br /> ❑ Other: (specify) 0 Multiple Family/Condo 0 Retainin Walls ❑septic <br /> 9 ( ) (Compliance certificate <br /> 0 Public 4-feet or greater may be required) <br /> *"Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Public Water <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 0Other:(specify) ❑ Other(specify) <br /> Phone: 952-471-0590 / Fax: 952-471-0682 ❑ Private Well <br /> www.minnehahac reek.orq <br /> Estimated Construction Valuation (excluding land) $ 1400 0° L+M <br /> Packet Last Updated: January 2016 <br /> Pano 91 <br />