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r , <br /> , � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, MailiPO B x 66. 1 a'�� Permit number. �p/7-O!d(l7 <br /> <yO , <br /> Crystal Bay, MN 55323-O O S6 O Date received: �'S`�� <br /> � ,, StreetAddress:' �� � Received by: <br /> �F! G� 2750 Kelley Par y � Pfan review fee: 17-O/D�Of� <br /> qkFSH���c. Orono, MN 55356 � ' /� �. <br /> Main: 952-249-4600 Tot Fee: <br /> Fax: 952-249-4616 wwyr.ci.orono rrin us �j�� �/7-OJD�� <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: ;, .. <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. Shuttle bus service ill be <br /> required unless applicant demonstrates su�cient on�site parking is available. Non-permitied events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N8171@: David Weekley HorriF,s <br /> State License# ac69�sns Expiration Date: <br /> Phone: (cell) s12.��6.2Ez, (o�ce) <br /> Mailing Address: �2soo wn�tewace�o���f, s��ce zo Cit : �n�n��to�,ka Z�P; 55343 <br /> COI1t2Ct P@fSOft: Kevin Cummins Applicant is: Contractor / Homeowner �a�ie o�s� <br /> Et1181�211C��0�FaX: �r�z;nmins(�dwhoilie�,co�n <br /> PROPERTY OWNER INFORMATION: <br /> Name: ^�:, . ,a�o�:,. <br /> Phone(day): �,�v'�; �z.a62.6�3? <br /> Address: �s�� City: ZIP: <br /> Email and/or Fax n,;� �n,e5.�om <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address _, E�t��,su�ce zso City: a�„���� r�<� ZIP: 1=+00; <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 ❑ O�ce/Commercial <br /> ❑ Relocation detached garage � Residence ❑ Private Sewer <br /> ❑ Other: (specity) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater � Pubtic Water <br /> ""Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review�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) $ zso,000 ��, � � r���� <br /> �t��a-�- <br /> CITY OF ORONO <br /> Last Updated: January 2016 <br />