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e CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A , Mailing Address: Permit number: �/�� �� <br /> l�lO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��"�3/ <br /> StreetAddress:' Received by: <br /> yF G� 2750 Kelley Parkway Plan review fee:���//,,3 <br /> �qk�SHp�h. Orono, MN 55356 � ��—� l�3 <br /> Main: 952-249-4600 Total Fee: ,/ <br /> Fax: 952-249-4616 www.ci.orono.mn.us o�0 /�—� / y 7`� �� <br /> This application form must be completed in full and all required information must be submitted. k <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ?j2.�7 �A'p V�v �il�-�l.l.� <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 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INFORMATION: <br /> Name: G 5 (�Vp (�O, t�•i•-(i <br /> State License# $(�(� 5 2. Expiration Date: -3 - <br /> Phone: (cell) 12., Z Z- (office GIZ Zo <br /> MailingAddress: tSOrjp , Cit : MotJT ZIP: rj�'j <br /> Contact Person: oL� Applicant is: ractor / Homeowner (Circle One) <br /> Email and/or Fax: p WOq ' Fj F,(t.G(� L�j'C�. <br /> PROPERTY OWNER INFORMATION: <br /> Name: pp C-o� t,.Lv <br /> Phone (day): ° <br /> Address: p�b Z . Cit : �•'{MO�a ZIP: �j�j��7 <br /> Email and/or Fax Jp0 C.o <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (/1� S !.l)'V'n C� <br /> Phone (day): � •'1,. Z• ,, <br /> Address: 15D o c�t :?�-*t�a�T�► ZIP: ��j��7 <br /> Email and/or Fax: a . <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> New Construction �ingle 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&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 excludin land $ �'�� �d� <br /> � 9 � ) �,:t�u i�ro r�n� <br /> � ; <br /> �N����� <br /> Last Updated.� January 2016 <br />