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./����- <br /> CITY OF ORONO � � <br /> BUILDING PERMIT APPLICATION / '(`�/�� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: � ' (,►�• � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: a <br /> StreetAddress:' Received by: � <br /> y � 2750 Kelley Parkway Plan review fee: � �� <br /> F <br /> �qk�s�o��,�' Orono, MN 55356 �Qr�_�Cc-�(.J <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: ' � �� " <br /> Job Site Address: (pJ�� ��7L+'Gvrs� C0.1�-fi <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 Departmenf 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-permifted events will not be allowed. <br /> CONTRACTOR/APPk I,C. ANT INFOR ATION: <br /> Name: /�d►'"�i'� �,$� �LL <br /> State License# � (o,3�'a-a—( Expiration Date: 3 j <br /> Phone: (cell) ( (office 3•$' <br /> Mailing Address: { , d Cit � ZIP: S.S <br /> Contact Person: O � Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: LLy�.�5���.}zYi ��,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: /�d�--h7r-� l-f-Dme.� L� <br /> Phone (day): �, -,S$'�j- �j <br /> Address: d� $� N . D Cit : ZIP: s�� � <br /> Email and/or Fax G h�-�-��cYr�,S �'.�L <br /> ARCHITECT/ENGIN ER INFORMATION: <br /> Name: ��� wnn: � s �. <br /> Phone (day): 71i • 7 (�- l/ ' <br /> Address: C �� �0� Cit : � Z�P:ss'yY <br /> Email and/or Fax: /n - <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Water Supply <br /> �w Construction '�Single Family with ❑Accessory Bldg./Garage <br /> ddition attached garage ❑ Deck ❑ Public Sewer <br /> ❑ ccessory 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 also require ❑Commercial ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑ arehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) ther(SpeCify <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ �, �bZ.� <br /> � <br /> Last Updated: January 2016 <br />