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7 - I5 <br /> 0 04 <br /> pa:, v,/,,,,,,;4. City of Orono (,'P` vo, <br /> ing Permit Application QQ •�3c <br /> 4 -----205 m3 -- <br /> i - i Structures or Additions <br /> r Address: <br /> Box 66 Permit number: 26 15-00 36 <br /> istal Bay, MN 55323-0066 Date received: h-{ —7-1s <br /> address:' Rec to y 12j)i7 <br /> 50 Kelley Parkwa Q L;•/ c3 in SIS 3 2 C,2 ,Er-Z —"------ <br /> c--\-4\an l DDm oy----e MN 55356 Plan review ee. / /— = l <br /> )52-259-4600 Total Fee: <br /> 52-249-4616 www.ci.orono.mn.us 11 /', t/I HIS dppiwduuii iviiii iiiuoi uc completed in full and all required information must .' ubmitt d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z3:�c r)//t2er- t-r"t 11 ( (-- ft U i*)lk-' S 3 S� �O+ (acfc1 Oi+%er- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dis• :y Home? ❑ Yes L No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days• .r to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted eve• . will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ( or4ork James (7onSTrKchhQn 1/uQ.- <br /> State License# 13C 5-3/ q 61 Expiration Date: g- 2.o /r7 <br /> Phone: (cell) / 2_ -f g 3 z 4 7 (office) 7 3 y7°l 3/I - <br /> Mailing Address: p o goy" 30 6 City:j'Vl4 P/,e p1Ai ZIP: 5-15-35-61 <br /> Contact Person: (4)/ /( / c_k Applicant is: w. tyc n / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER F•R 'TION: r + <br /> Name: i 0/ earn-e-e- )(elf°n <br /> Phone(day): co /2 - C,3 G - 3. " i ` p <br /> Address: /1G,-3 Z'7 r ,A�,d- N City: ( Z-c ,4cocr7>< ZIP: SI---,7477 <br /> Email and/or Fax JA,t�c-s,,-,f C-00-c4-3-7: Nc i <br /> ARCHITECT/ENGIN,FER INFORM ' ION: <br /> Name: a vl 13 re v cr <br /> Phone(day): gS/- 3y 27! <br /> Address: -2-2-& H rtte__ S ree - t r4i r re( City: S-r<i(f ,ter MA/ZIP: 35D F-2- <br /> Email <br /> 2Email and/or Fax: ,_.e,,'I cr .Port bren n er-are-.t1-ec-i-S .caer‘ <br /> PROJECT INFORM ' ION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> it New Constructi. Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage El Deck 'l Public Sewer <br /> ❑Accessory : •riding ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocatio• detached garage a 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 El 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.org <br /> Estimated Construction Valuation (excluding land) $ 1'3.30, COO <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />