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r`. City of Orono <br /> Building Permit Application <br /> r for New Structures or Additions <br /> Mailing Address: Permit number: 2.oI '-X 1(1 9 <br /> 0 PO Box 66 <br /> f VQ Crystal Bay, MN 55323-0066 Date received: 0? I' I to <br /> Street Address:' V w v i sal__ __ Received by: <br /> y , 2750 Kelley Parkw � <br /> c> Orono, MN 55356 O(b-O0��[� Plan review fee: 2 d y S 9 • <br /> lAXESHO��' 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: 11 �q <br /> Job Site Address: 70 0x-0.00O rnl CO Crow //t N <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ] Yes ❑ No UNC <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: IK R a' )40IM S- <br /> State License# ¢4 (,f,3 fs9 Expiration Date: •/3/l c?()d-7 <br /> Phone: (cell) G 1,a so Salvo (office) _Stip")t. <br /> Mailing Address: ,•'tb ; Qac, Mk Cit : -- rove- ZIP: S'S3i/ <br /> Contact Person: . 0'a 4Q Applicant is: ontrac or / Homeowner (circle one) <br /> Email and/or Fax: Z J/crr J CONI 0 C0/40.ST t MET <br /> PROPERTY OWNER INFORMATION: <br /> Name: TEFF JRti4t3 *' To kw R1tv:"VEcco <br /> Phone (day): (pia -4.So --Sa(cu <br /> Address: ►(. B/0 ?,c' race NAR rk City: Mope u(,. ZIP: �5'.3Jd <br /> Email and/or Fax 4igi u.J KR0T(Om C'can,,C r T ,.NET <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: t iS/'mpI vv. <br /> Phone (day): *Gv^py S!o ( (../-a) <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Al--e-Lt.) >Ll <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> grNew Construction <br /> mingle Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck I "Public Sewer <br /> ❑Accessory Building 0 Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage 0 Residence <br /> ❑ Private Sewer <br /> ❑ Other:(specify) 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> 0 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 ( Krivate 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 /> Estimated Construction Valuation (excluding land) $ 5.;8i000 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />