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CITY OF ORONO <br /> • BUILDING PERMIT APPLICATION e_S /..o„j parj 0A2-,(--1__ <br /> FOR NEW STRUCTURES OR ADDITIONS Plc-k-- rfkg-' <br /> ,iLO�V Mailing Address: Permit number: �O! 3y <br /> PO Box 66 <br /> O Crystal Bay,MN 55323-0066 Date received: 3/41/ p <br /> Street Address:' Received by: /04/L' <br /> S L� 2750 Kelley Parkway Plan review fee: $,2(40„(0 7 <br /> F <br /> t4kEst-101- Orono, MN 55356 C e '-ysb LJ <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: y77J �y <br /> Job Site Address: 7 us1 _ 5 / <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT_ INFORMATION: <br /> Morton dr On H-ornes, LCc, <br /> State License# gG (a39 p2-1 Expiration Date: Y• 3/•/7 <br /> Phone: (cell) (0/3.3nb-7b4 / (office) 703• 5'75'9.a-99/ <br /> Mailing Address: 1$'.?-j S L//$ /3-y� N Sk-, 0 Citi: town, ZIP: Ssvy,6 <br /> Contact Person: Chris N Applicant is: tr / Homeowner (Circle One) <br /> Email and/or Fax: CI-1r)S l norfen/laches- (a-)-, 4447 y Bella' '1 he e-n es.Gar, <br /> PROPERTY OWNER INFORMATION: <br /> Name: SclVfc Lag- - Dead oPme,-,t <br /> Phone(day): 7L? • sS/• C)l 00 <br /> Address: /j;7'15 y$ 9.'t N Sde. D City: P!y/nod/1, ZIP: ,S.s�Cf to <br /> Email and/or Fax •}'1, & Soiree./a41.4. cc;-,..,.. / <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: acro !1r2oGs - Bev)bAc1 AfS1''9 ,- ch,4 c .� <br /> Phone(day): /3 •S? y7 (/ <br /> Address: 9.55(/ V ,(74 s� _ City: Elft✓e., ZIP: 55-33a <br /> Email and/or Fax: ,8Pvarta-4e-J'f'n Lirvin& he f,n if. Curr, <br /> PROJECT INFORMATION: Description of project: lV g•�1 aer2t<7ca 51 aq id, t/ +�/C..2 r <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disp al& <br /> Water Supply <br /> New Construction ,Single Family with 0 Accessory Bldg./Garage <br /> ddition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building El Single Family with El Office/Commercial <br /> ❑Relocation detached garage illesidence 4 Private Sewer <br /> ❑Other:(specify) El Multiple Family/Condo ERetaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require El Commercial El Storage <br /> MCWD review&permits. El Industrial El Warehouse Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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.orq <br /> • <br /> Estimated Construction Valuation(excluding land) $ /J 000 <br /> Last Updated: January 2016 <br />