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/ � <br /> City of Orono n��• <br /> vl � <br /> Building Permit Application � �`?. I� <br /> for New Structures or Additions l� c ��'� <br /> � 1 <br /> Mailing Address: Permit number: ��� ��� <br /> �Q A>O PO Box 66 <br /> `V Crystal Bay, MN 55323-0066 Date received: —�� —/ <br /> StreetAddress:' Received by: � <br /> 2750 Kelle Parkwa J-�'9� �j s <br /> �F �` Orono, MNy55356 y Plan review fee: <br /> !�'�FSHo�� Main: 952-249-4600 Total Fee: �U� '�-�� 7 � <br /> Fax: 952-249-4616 www.ci.orono.mn.us LX.Y�W+- Ycd� <br /> This application form must be completed in full and all required information must be bmitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: -�,(�� ��e��-� Ro�p <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �lo <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 I ORMATI N: . <br /> Name: �'1'1 e l.�, � 5�-2u.c.Q-�owJ <br /> State License# CSpc 1 p Expiration Date: 3 '� <br /> Phone: cell �— p�( office <br /> Mailing Address: D �- `b Cit : /j� n � ZIP: <br /> Contact Person: J�g�i���L�-� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: '�C��,,�,, [c� �.n�v� aNy . �,er�,r` <br /> PROPERTY OWNER I FORMATION: <br /> Name: � � G u � <br /> Phone(day): qS — <br /> Address: (ob Cit :� ►.l0 ZIP: � 33� <br /> Email and/or Fax GT�a.q�.� p�.� h.�.Rsk@�`a�r}�i.cM. .C�x <br /> ARCHITECT/ENGINEER INFORMAT IVj � <br /> Name: �fi'rh G ,�3,0.�1 <br /> Phone (day): � f2 2�p '$$(o$' ! <br /> Address: '�'3Z $qp��,S_ r,up� �� , City:��Cs�r,oA/ ZIPJS/� <br /> Email and/or Fax: _ �p_�so4J -E-a,i � C�Me.tLs�. N <br /> PROJECT INFORMATION: Description of pro�ect: <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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� oc� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />