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�`�,�li� <br /> CITY OF ORONO � � �' <br /> BUILDING PERMIT APPLiCATlON ���' �'� <br /> � <br /> FO EW STRUCTURES OR ADDlTIONS <br /> t� � � Mailing Address: ��� Permit number: C � � "C�:�, <br /> r" �O �� PO Box 86 �•� � � <br /> G) Crystal Bay, MN 55323-ad6 Date received: �- � � —� � <br /> ., ,. In�l Street Address:' ------ Received b : F=�--� <br /> y�n` L�'� U� 2750 Kelley Park ay L`,��_��' �� lan review fee: `��'� � �-'�� , <br /> �aK�.s�i���c Orono, MN 55356 <br /> _� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us � u,�� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplste appilcations wilf be returned. (Please prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: '�,,,U2 S A& (,�Jif6 �a«.� Q�LY�v fV�1J �,�j°'�� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? Yes No <br /> If yes,a specia!event permit is requrred wrth Police Department and Crty Counci!approva!60 days prior to lhe event. Shultle bus servlce wi! be <br /> required unless applicant demonstrates suf/rcieni on-site perking Is availabfe. Non-permitted evenfs wiil not 6e allowed. <br /> CONTRACTOR/APP CANT FORMATiON: �� <br /> Name: ,e �D� <br /> State License# Expiration Date: <br /> Phone: cell Z S � / � office �2 <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: -C Applican�is: ntractor / Homeowner (Cirele One) <br /> Email and/or Fax: � ,c r.� �?V�.c�� � <br /> PROPERTY OWNER 1_N�ORMAT�QN: k`R� <br /> Name: �,1nn. r f� <br /> Phone(day): (s�2,-- --o��'�` <br /> Address: . w�Q Cit : C��v ZIP: �'.3q � <br /> Email and/or Fax n, Q o � <br /> ARCHITECT 1 ENGINEER INFORMATION: b�'1JUm�n• e� {Gj�,({�l � G�mud'�• C� <br /> v <br /> Name: <br /> Phone(day): <br /> Address: City: ZiP: <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: Descri tion of ro'ect: ����-�� ��r� 1"�C�-� —��-�r�<<r -' <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Dlsposal 8� <br /> , _ _- WaterSupp�Y <br /> ❑New Construction ❑Single Family with ccessory Bidg /Garage <br /> ❑Addition attached garage ❑Deck C _ Public Sewer <br /> [��ccessory Building �ingle Family with ❑O�ce/Commercial <br /> ❑Relocation detached garage ❑Residenoe ❑ Private Sewer <br /> ❑ Other:{specify) ❑Multiple Family/Condo ❑Retaining Wati(s} <br /> ❑Public 4-feet or greater ❑ Public Water <br /> k3Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed Disirict MCWD ❑ Private Well <br /> ( ) ❑Other: (specify) ❑Other(speciry} <br /> 15320 Minnetonka Blvd , <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacr k. r <br /> Estimated Construction Valuation (exduding land) $ Z�',Q�� <br /> Last Updafed: January 2016 <br />