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� I�b �r �e. � �l�����l <br /> . � <br /> City of Orono <br /> Building Permit Application <br /> r for New Structures or Additions <br /> � Mailing Address: Permit number: —�� <br /> QA, PO Box 66 <br /> � `v� Crystal Bay, MN 55323-0066 Date received: - ��/� <br /> Street Address:' Received by: !5—(JD <br /> � ,� 2750 Kelley Parkway <br /> y�' c,` Orono, MN 55356 Plan review fee: � , <br /> ��kFs}.�0�� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 v�-���-c,.ci.uror��.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: 3� <br /> Job Site Address: o � �1.�v r,� �t� V <br /> Will this be a Parade of Homes emo elers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e 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: .V �' uv� ,5�. <br /> State License# f�` � �- �.L ;?<' ;� ��."=�� �'�� Expiration Date: '3 i '� <br /> Phone: (cell) �� �.-� �� ��L� (office) <br /> Mailing Address: ,r- - _� v Cit : �i.,ti�-" o., '3ZIP: , �� f <br /> Contact Person: � � -;v� � ✓1 Applicant is r$�facfo� / Homeowner (Circle One) <br /> Email and/or Fax: 1<G/I iC�� ��Y1 k�_�'10'.E:�c.�• ."��:*<€�� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��L� �j � v� <br /> Phone (day): ��_ l Z' `� l 2- 06�j-�=�� 6l <br /> Address: _��;}[� �: i,c>�� I���t VL., City: (�►'-U✓+ !� ZI P:Jc�%�- � ' <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 /> �.Qddition 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 Valuatio;� (excluding land) � �.5 U�Cl <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />