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CITY OF ORONO <br /> BUILDING PERMIT APPLICATIDN <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �Q� Ma!ling Address: Permit number. (� ( �; �db�� f <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-U066 Date received: ���� —� <br /> ., ,, Street Address:' <br /> Received b : P� <br /> y�. L�~ 2750 ltelley Park ay����_ , �,,""�� lan review fee: �3� � S�- <br /> ��K�s�io��: Orono, MiV 5535 � <br /> Main: 952-249-4600 Tota1 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 submitted. <br /> Incompiete appllcations wili be returned. (Please print) <br /> GENERAL INFORMATION: <br /> JobSiteAddress: 'Z.,UZ ,� a& (,y/i� �«.� QjL�� �V�lJ j�,�J-°�� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? Yes No <br /> ff yes,a specia!event permit is iequrred with Police Department end City Council approva160 days prior to the event. Shuttle bus serv�ce wi! be <br /> raquired unless applicant demonstrates sullicient on-slte perking Js available. Non permifted events wi!!not be allowed. <br /> CONTRACTOR/APP CANT FORMATION: � [/ <br /> Name: ,e �� �D v� <br /> State License# Expiration Date: <br /> Phone: cel! Z S � / � office S 2 <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: -C Applicanf is: n ractor / Homeowner �Clrela One} <br /> Email andior Fax: ,���. �hM.�• 1 � <br /> PROPERTY OWNER IN ORMAT N: <br /> Name: ,:�Z�nn. r � ,c.�R.�'�Qf <br /> Phone(day): (��2— �-o��'Y` <br /> Address: . w�sa Cit : CX�u ZfP: �'.3`� ( <br /> Email andlor Fax n, Q ., <br /> ARCHITECT/EIVGINEER iNFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Emall and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: �E'`��L}�C'C� ��r� ' <br /> 1.Type of ProJect 2. Proposed Use 3.Structure Type 4.Sewage Dlsposal& <br /> ❑New Construction ���- Water Supply <br /> ❑Single Family with ccessory Bldg /Garage <br /> ❑Addition attachec!garage ❑Deck Public Sewer <br /> [�C�ccessory Building �ingle Family with ❑O�ce/Commerciai <br /> ❑f2elocation detached garage ❑Residence ❑ Private Sewer <br /> ❑Other:(specify) ❑Multiple Family!Condo ❑Retaining Watl(s) <br /> ❑Public 4-feet or greater ❑ Public Water <br /> •kAny earth movement may also�equire ❑ Commerclal ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Wate►shed District MCWD ❑ P�ivate Well <br /> ( ) ❑Other:(specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-d71-0590 <br /> Fax: 952-471-0682 <br /> www minnehahacr k. r <br /> Estimated Construction Valuation (excluding land) $ 2�",Q�� <br /> Last Updated: Janusry 2016 <br />