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' ' City of Orono �,�" <br /> � c��' <br /> Building Permit Application � <br /> for New Structures or Additions <br /> ---. Mailing Address: � <br /> PO Box 66 Permit number: <br /> ' ����(�����., Crystal Bay,MN 55323-0066 Date received: �� — <br /> '`� µ Street Address' Received by: <br /> \� � ' 2750 Kelley Parkway <br /> t � Orono,MN 55356 Plan review fee: <br /> � <br /> � �`���}it��''t ' Main: 952-249-4600 <br /> Total Fee: <br /> Fax 952-249-4616 <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: ;,3�> Cy � i ��,.,;,, yr��, ��� ( ;.� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home7 ❑Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to fhe evenL Shuttle bus service will be <br /> required unless applicant demonstrates suflicient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA'N�Nf ORMATION: <br /> Name: % t- <br /> State License# Expiration Date: • <br /> Phone: _(cell) (office) <br /> Mailing Address: City ZIP <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��vr_ �_�7�r'�� <br /> Phone(day): ?,�s,� C�'�, �yc�y <br /> Address: „�t� �fGY.0 O,�l�r�u � City �'�'C��1�J ZIP SS 3�j � <br /> Email and/or Fax 5�a• , c p-4y� � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City Z�p <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro ect: <br /> 1.Type oi Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ,�Q New Construction ❑Single Family with �Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑Public Sewer <br /> ❑Relocation g y ❑Office/Commercial <br /> detached garage ❑Residence <br /> ❑Other:(specify) ❑Multi le Famil /Condo ❑Private Sewer <br /> P y ❑Retaining Wall(s) <br /> ❑Public 4-feet or greater ❑Public Water <br /> "Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnenana ereek watersned oistnct(MewD) ❑Othec(specify) ❑Other(speeify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 — <br /> Phone�. 952-471-0590 <br /> Fax�. 952-471-0682 <br /> Estimated Construction Valuation(excluding land) $ ����v�� <br /> Packet Last Updated:August 2015 <br /> Page 21 <br />