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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � �O� MailiPO Box 66• Permit number: � —��� � <br /> � Crystal Bay, MN 55323-0066 Date received: 7/ �— 7 <br /> �, ,, Str�et Address:' �li� , r � Received by: � <br /> y�. �: 2750 Kelley Parkway�� �,� � Plan review fee: �,�S. �� <br /> �qK�SH���c Orono, MN 55356 p _� g� <br /> Main: 952-249-4600 I Total Fee: � t � <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: . �y nj' ' � <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 Department and City Council approval 60 days prior to the event. Sh !e bus service wiU be <br /> required unless applicant demonstrates suff'icient on-slte paricing is available. Non-permitted events wid not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � +v�-,�.:�E�v i-� f �.� <br /> State License# �� t,����.ts Expiration Date: <br /> Phone: (cell) s�z.��szsz� (office) <br /> M81�II1g AddfeSS: 12800 Whitewater Drive,Suite :'' Clt : Minnetenka Z�P: 55343 <br /> Contact Person: KPv�n cumm��s Applicant is: Contractor / Homeowner (Circte One) <br /> EI'T181�811C��0('FaX: k� ,m::,�.� c:vk�,o��ncs,mn�i <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> phO�e�day�: Meil,sa Johnsen oi2.462.6932 <br /> Addl'eSS: �same As Above* Clty: ZIP: <br /> Eflle'�1�811C��Of F8X mjonnscn@dwhomes.cr_:n <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): �=,��soo� <br /> AC�C�f2SS: 20 South Maple StreeC,Suitec 15Q �ilty: ���nb'.r��,���, Z�P: 19001 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Desc�i tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> 0 New Construction 0 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 0 Public Water <br /> **Any earth movement may also require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse ❑ 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.or <br /> �V�� <br /> Estimated Construction Valuation (excluding land) $ zso,000 <br /> �JUL 1 4 017 <br /> Lasf Updated: January 2016 CITY OF ORONO <br />