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.� � i� i r�d Z/��/r� <br /> . er �n � <br /> , '. City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit nu er: ���� �- ; Z,` <br /> PO Box 66 <br /> � � �0 Crystal Bay, MN 55323-0066 Date rec ed: 1 l��-- l L, <br /> Street Address:� eceiv by: �'-� <br /> -- <br /> ,� 2750 Kelley Parkway ,�-- —� � �j <br /> �� L` Orono, MN 55356 � �!��� �C,'l ��' Clan eview fee: t�j , � <br /> qkf5H0�� Main: 952-249-4600 _ C <br /> ___— _ � T al�8e-_— <br /> Fax: 952-249-4616 :�.�:�z�v,�_ci ororio.�Tin us <br /> This application form must be completed in full and all required inf ation must be submitted. <br /> Incomplete applications will be returned. (P ase print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 53 � Ly r� j c /a�t ��� M � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or er isplay Home? ❑ Yes 0 No <br /> If yes, a specia/event permit is required with Police Department and City Council approv 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-per ed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: r � IZ <br /> State License# a Expiration Date: i <br /> Phone: cell f� � - y _ y �� office <br /> Mailing Address: � v ,4 .� ,�P„ d . Cit : M �,,, d ZIP: 5 � <br /> Contact Person: 4,,,� „ ,- d Applicant is: Contractor / Homeowner �c���ie o�e� <br /> _Email and/or Fax: ti ,.. s,d r� .. r►� <br /> PROPERTY OWNER INFORMATION: <br /> Name: I:��; d <br /> Phone (day): - - 1 <br /> Address: �bo I � Cit : M ,,,,. ZIP: SS � <br /> Email and/or Fax �:t�;r. � rh 2�- .. .. <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: /� „ ��,,, <br /> Phone (day): y o - �ty -o <br /> Address �� U `^�f i �`M�,- - • i ' � Cit : C� � ZIP: i <br /> Email and/or Fax: u � 2 �.,.� � - o e -� <br /> PROJECT INFORMATION: Descri �on of project: ������'.�-�-� �-' �:"��r�`14�- <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 r uire ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed Dis ct(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) $ � 0 Q i v o p <br /> � <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />