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, , <br /> . <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ����p—�� Q <br /> � �Q PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: D�()�' � <br /> StreetAddress:' f�� Received by: � <br /> y ,�- 2750 Kelley Parkway '�I Plan review fee: <br /> F c.� Orono, MN 55356 V <br /> l�kESHO�� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 v��a�w.cLoror7c 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: I <br /> Job Site Address: �� 9 D ��.o� �Oa <br /> Will this be a Parade of Homes, Remodelers Showcas Home or other Display Home? ❑ Yes ❑ No <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 INFORMATION: �, , <br /> Name: Cc��.�� tv���---`� ���ti�i-�-..<.c:;z ���,-� �L.c._ <br /> State License# �j� �,�y�-7p��C� Expiration Date: <br /> Phone: (cell) �lZ--(v l�-� -�-! c��7� (office) 5t�m E <br /> Mailing Address: 1 YI�W ���-5 �:�-2c_L-�- Cit : La�Ct v.� ZIP: � �r�4�1- <br /> Contact Person: -;i�y�,i.�-t-� Applicant is: ontractor_� / Homeowner (Circle One) <br /> Email and/or Fax: �i,�c���.;�,., — �L�cL;,� rz,r',�,��- <br /> PROPERTY OWNER INFORMATION: <br /> Name: e� �ct-�.-� r'�- ���T�c=�r= <br /> Phone (daY)� �nf�g Zl 3 - `F�'Z� <br /> Address: �4 5� � c��xQ _ � Cit : ��,vc� ZIP: <br /> Email and/or Fax n,tc� o� �jl�.E �c c ,C�, , <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 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑9ccessory Bldg./Garage � <br /> ❑Addition attached garage ��Deck Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> �Relocation - �aG�tc t��'�L'.'`��'1 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 /> Estimated Construction Valuation (excluding land) � � �� <br /> � All(� n 1 �n� <br /> Packet Last Updated: August 2015 CITY OF ORONO <br /> Page 21 <br />