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. �� <br /> � City of Orono �`� �� <br /> Buildin Permit A lication � <br /> J pp <br /> for New Structures or Additions <br /> _ Mailing Address: /� <br /> '�O�O PO Box 66 Pennit number: �l(p -� Z <br /> / Crystal Bay, MN 55323-0066 Date received: �—�v j <br /> � Street Address:' � �f Received by: <br /> �, ���, ,� � �� 2750 Kelley Par ay�������d�-I n r 'e • e: • � � 3 <br /> `. F \ ` Orono MN 553 --- -' <br /> �� , <br /> `�'�ki,ii�,��:/` `� Main: 952-249-4600 Tota)Fee: <br /> �_ / <br /> �--� Fax: 952-249-4616 www.ci.ornno.mn.us v <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: � ��-�- � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a special event permit is required with Po/ice Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �- �l E D�Iftv i5�t,1 (-�D <br /> State License# �G � � �$'� Expiration Date: 3 /31 / t8 <br /> Phone: (cell) q52 3ti3- 4�c►"1 (o��) <br /> Mailing Address: ,fl. os� � Ci : S ZIP: 5S3 I <br /> Contact Person: Applicant is: c o / Homeowner (Circle One) <br /> Email and/orFax: ,.o� „��(-h�SPr�.P.b�7n b�.� bl • �on�.- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �(LJ Ar� 3 a-A�rJ T/�R- <br /> Phone (day): (0(2 ' �p�� - (D(pbl <br /> Address rN16 l�lG- .D City: �Q,/��' ZIP: 55.3.SG� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: [�,✓G�!L�`�I PKZ-fi�f"�i EGT3 <br /> Phone (day): �t� (,C�2- $'Ysb <br /> Address: ��Z'1S /►��,�C,g'f" ST C�tY= lYl�lS Z�P: �SS�Ds <br /> Email and/or Fax: (��v- �I2. - gY�.�f <br /> PROJECT INFORMATION: Descri tion of ro'ect: C�t �� � c.�'V�__ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑Deck �Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage �Residence ❑Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo Retaining 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 /> O, www.minnehahacreeK.or <br /> Estimated Construction Valuation (excluding land) � �r�, c�d� <br /> � Packet Last Updated: August 2015 <br /> Page 21 <br /> ' <br />