Laserfiche WebLink
� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �O` �_�b C� / <br /> 0 PO Box 66 Permit number: J ,b <br /> � �� Crystal Bay, MN 55323-0066 Date received: �---aZ —� <br /> Street Address:� Received by: <br /> y� ,� 2750 Kelley Parkway Plan review fee: � -/ 33. 5 <br /> c,` Orono, MN 55356 <br /> �qk�sHo�`�` Main: 952-249-4600 Total Fee: �����i5 <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 will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3201 5l�.D o Ct 2C1.� L�� � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display ome? Yes ❑ No <br /> If yes,a specia/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 sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: G!�►Ct.�.-EYr G�.tDb �� L.•L .G , <br /> State License# _�G C�352�4-5 Expiration Date: 3 _ 3 (- ?��j <br /> Phone: (cel I) �.t t� 490- '7(�-Z� (office) Gr z- 3s9 -1709 <br /> Mailing Address: 0 2 i� . c Z Cit : ZIP: - <br /> Contact Person: S '1/'� L�GI�T�' Applicant is: on rac r Homeowner (Circle One) <br /> Email and/or Fax: ��s,µT � CH-,�t��.""'S CuoO . Gfl t'K <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��.t.!-12C.t'�S C u�0 CA• L.l_,C� . <br /> Phone (day): G,1 Z- 35"�-- /70 9 <br /> Address: �y-�� ZgKO pyE'� /�oQ,�-f City: �„YYMeL1T1-F ZIP: SS��-7 <br /> Email and/or Fax ��„��,�- Q CPhn•.IZL„t..^5CLlpI�. C0�'�l <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �N.p/Zt,� GL�DO Lo� L •L.G� <br /> Phone (day): - 70 <br /> Address: �S'D$79 z 3/� E- . /�/027�{ City: r'JL�/Itla t!)7-�F ZIP: $'S¢¢-� <br /> Email and/or Fax: t„�t, t Ghfl4,/Z.L,ESCt,ytlO . Lo� <br /> PROJECT INFORMATION: Descri tion of ro'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&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 /> $ � <br /> Estimated Construction Valuation (excluding land) ,�9'(y � OQv p „ r, „ ,., , ., <br /> � ��� <br /> Packet Last Updated.� August 2015 CITY OF ORONO <br /> Page 21 <br />