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f <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � o��',b� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> , � 1� <br /> OA, Mailing Address: Permit number: ( �-� <br /> �' `vO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��/ -1 7 <br /> � ,, Street Address:' ����1 Received by: "" C•/�_� <br /> �F G� 2750 Keiley Parkway ��I Pian review fee: �/,�3Jr 7!� <br /> lqkfSHO�� Orono, MN 55356 G p2 17 — <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 submitt . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <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 approva160 deys prior to the event. Shutt/e bus service wdl be <br /> required unless applicant demonstrates su�cient on-site parking rs available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � ,� .�. �, �, <br /> State License# �_�,=E�����s Expiration Date: <br /> Phone: (cell) s�2.��s z�z�� (office) <br /> M81�Iftg AC1Clf@SS: 12800 Whitewatcr[ r� :�.S t� 20 Clt : Mln��et<�r�,k� z�P 55�='+3 <br /> COt1t8Ct P@fS011: t<e:vin Cummins Applicant is: Contractor / Homeowner (Clrcle One� <br /> ER181� 811Cj�01'F2X: r��,mrninsi�'dwliorn=-��_.;,.-�; <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,� :�, � <br /> Phone{day): �:^�-i�ssa�onnson 61z.�6z.693z <br /> Address: -s,�„F a5 ab�ve� City: ZIP: <br /> Eh181�BfICi�Of F8X mjohnson�v�v:he.nc�s.cx��� <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: ��y,�,��,��.�,,. <br /> Phone (day): z:�s.6nc koo� <br /> Address: zo so��tr,M�p�E ��� 1 �,.�t� ���.�: City: �> >��'��r,Fa ZIP: 1-300� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 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 /> Estimated Construction Valuation (excluding land) $ zsc�,000 �i��, ���n�_ <br /> CITY OF ORONO <br /> Last Updated: January 2016 <br />