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-� City of Orono ` <br /> � � � s�d 5�7 � <br /> Building Permit Application �� <br /> for New Structures or Additions <br /> Mailing Address: Permit number. �l�� �J <br /> �A, PO Box 66 <br /> � �v0 Crystal Bay, MN 55323-0066 Date received: N'(��' f <br /> StreetAddr�ess:' Received by: <br /> y ,�* 2750 Kelley Parkway Plan review fee: �f 9•�� <br /> �' c? Orono,MN 55356 <br /> ��kESH��� Main: 952-249-4600 oZOI �QD �3.� <br /> Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <br /> / 0(36_ � <br /> This application form must be completed in full and all required information must be subm' ed. <br /> Incomplete applications will be neturned. (P/ease print) <br /> GEN�RAL INFORMATION: . L <br /> Job $ite Address: s �No `�, � A� �A �ff'�� �1 �-�3S <br /> Will this be a Parade of Homes, Remodelers owcase Home or other Display Home? Yes No <br /> ffyes,e speaa/e�rent permit is required with Police Dspartmenf and City Couna/approval 60 days prior to the e�rent Shutde bus seivice w�i be <br /> requlred applicant demonstrates suHicient on�ite parking is a+railable. Non-permitted events wHl not be aUowed. <br /> CONTRACTO /APPLICANT INFORMATION: <br /> �,��gy co�sT2u�rro� , ��c <br /> State License# _ 7 4.gQ�' Expiration Date: ,e��p—/� <br /> Phone: ceil 7 g S 17 office <br /> Mailing Address: f1 N c� : � m ZIP: <br /> Contact Person: �ER£my W ood qs� �o� ��Z g Applicant is: Contractor omeowne �ci�ie o�� <br /> Email and/or Fax: <br /> PRO�ERTY OWNER INFOR ATION: <br /> Name: t A 1��I G va� <br /> Phone(day): � y <br /> Address: SPRl�1 Ll � Cit :tN�`ILA7�) J�ZIP: �53� <br /> Email and/or Fax _�I ,I�'I cN A2bs N�CO�(�t��� • �01'Yl <br /> �–" <br /> ARCWITECT/ENGINEER INFORMATION: <br /> Nam�: CUSTaM �ES l�N �i► bRA�T/�V� , I t�1 G <br /> Phone(day): � � sq <br /> Address 4�y S' S PRU CE I�V City:/17qpLE PLg•N 4'b+z�P: S g 359 <br /> Email and/or Fax: <br /> ARCHITECT!ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PRO ECT INFORMATION: Descri tion of project: <br /> 1.Type of Project 2.Proposed Use 3.Struature Type 4.Sewage Disposal8 <br /> ❑New Construction INater Supply <br /> �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> �j Relocation n M'��/ d 1�� detached garage �Residence �Septic <br /> ,�]Other.(specify) K L /'d ► i0n� ❑ Multiple Family/Condo Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4feet or greater may be required) <br /> *'Any earth movement may require ❑Commercial ❑Storage <br /> MCWb revlew�permlts. ❑ Industrial ❑Warehouse ❑Public Water <br /> Minnehaha Creek Watershed DisUict(MCWD) �p�er(speCify) ❑Other(SpeClfy) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 �Private Wel) <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ <br /> Packet Last Updated: Janusry 2016 <br /> Page 2! <br />