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CITY OF ORONO � <br /> . � <br /> ''�- BUILDING PERMIT APPLICATION ! �g � 3 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: o�'�(p - ���jo <br /> 1 VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —/ �i� <br /> Rec ' • <br /> � StreetAddress:' - O � <br /> ti�. G'� 2750 Kelley Pa �� v�v +�lan review fee: <br /> t�kESHO�� Orono, MN 553 L <br /> Main: 952-249-4600 Tota ee: ��� � ���a <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: � � (�ct�.��i�� ��'E , �� �� (�j� 5 5 3� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home o other isplay Home? ❑ Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �.e-w�►�'cxw�aw. �rt,�c�sv� ��c. . <br /> State License# (., C�Q 4 ��xpiration Date: �� A � <br /> Phone: cell �(Q?j - 2 2�i - 1,�O office <br /> Mailing Address: q 0�v� G�i,� _ 1� � Cit : ac1� ZIP: `� 3 Z <br /> Contact Person: ''�c�vv� ��,w.w�;r r,-�ca,L. Applicant is: Contractor�, / Homeowner (CircleOne) <br /> Email and/or Fax: L�.v�c.@-+ti ��C @ v�n ��('� � <br /> PROPERTY OWNER INFORMATION� ��i <br /> Name: s-�'�V�(; �^ i• '1 hl �Y�S <br /> Phone (day): '76� °- 3 Q - 3 o <br /> Address: -�i3• 'Bp X io 1 Cit : 1 � hn� Z�p; J J�� <br /> Email and/or Fax W�. v�-SS c+ O.�ti . <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: �{'�� <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 <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑ 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 ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eci ❑ Private Well <br /> 15320 Minnetonka Blvd � P �� ❑ Other(SpeC'tfy) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) <br /> $ '�.�'Q � � � <br /> ,_ � <br /> CITY OF ORONO <br /> Last Updated: January 2015 <br />