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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: t(v "'� <br /> .�(�p,O PO Box 66 <br /> `w Crystal Bay, MN 55323-0066 Date received: l—��/ <br /> � StreetAddress:' �_ Received by: <br /> �.� ,� 2750 Kelley Parkwa ��j��� r � <br /> ti� ��(� � �lan revie fee: - <br /> –.. <br /> � c,` Orono, MN 55356 �,_(�Z� ____---- <br /> q'�FSHO�� 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 wiil be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: ��� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> !f yes,a specia/event permit is�equired with Police Department and City Counci/approvaf 6b days prior to the event. Shuttle bus service will be <br /> requi�d un/ess applicant demonstrates sufficient on-siie parking is availab/e. Non permitted events will not be aUowed. <br /> CONTRACTOR/APPLICANT INFORMATtON: <br /> Name: �, �t( E D���t� b�+l,l f-D <br /> State License# f�G !o Y 'l$'?, Expiration Date: 3 /3l f iS <br /> Phone: (cell) q52, 3ti3- '�tL�"1 (o��) <br /> Mailing Address: ,fl. osL � Cit : S Z�P: 553 1 <br /> Contact Person: Applicant is: c o / Homeowner (Circle One) <br /> Email and/or Fax: ,.o� ,��h�sp�,eb�7n b�t� bl • �o t�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: (�(L! P1r� l�R-�A-ri1 �N�YL— <br /> Phone(day): <br /> Address: j�16 f''�IG- .0 2, City: �(1,/� ZIP: S.S.3.S� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (�,✓G L�i L�`.1 �b(Z.Gb�(Zi'EGTS <br /> Phone(day): �t r Z, b�+2- £�4lSb <br /> Address: ?�S 2'15 I►'�f�.K.G T S T; C�iY= lYI p�S Z�P: .��/D.s <br /> Email and/or Fax: 6�-i.. �Z. - �p�j <br /> PROJECT INFORMATION: Descri tion of ro'ect: G1A�/ � 6YY� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑Deck �Public Sewe� <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage �Residence ❑Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ftetaining Wall(s) <br /> ❑ Public 4-feet or greater �'Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑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.or <br /> Estimated Construction Valuation (excluding iand) � ���, t7�70 , <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />