Laserfiche WebLink
, CITY OF ORONO <br /> �UILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,O Mailing Address: Permit number: aD/(p L�O�,9 <br /> �V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � -�"') � <br /> ,� Street Address:� Received by: �� <br /> y�. G� 2750 Kelley Parkway Plan review fee: ` � <br /> `�kESH��� Orono, MN 55356 �y� 5� �'�_ . r� <br /> Main: 952-249 4600 � ( Total Fee. ��� <br /> Fax: 952-249-4616 �vvr���.ci.orono.mn.u� r <br /> This application form must be completed in full and all required information must be sub 'ted. <br /> Incomplete applications wili be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I Uu vl,�v�c;� �� �'�v��- /l/Il`U <br /> Will this be a Parade of Homes, Remodele s Showcase Home or other Display Home? ❑ Yes No <br /> lf 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 /> requrred unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM ATION: <br /> Name: �ch,ti1 S Ic�v�d 'ct � d- � _ <br /> State License # _(� �y Expiration Date: <br /> Phone: _�cell) (���Q _ jq z�P (office) <br /> Mailing Address: �� /� - �( r Cit � r�. ZIP: � 7 " <br /> Contact Person: �'V���C� W,��h Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: �ti�e.l,�,�,2��,�c�y,� /�t�,,�S (�K S��d,h�, c'�sw, <br /> PROPERTY OWNER INFORMATION: <br /> Name: n/1� 1�+� �'(�cw� �-�- `+J26 LAA u�'l� l�1'� G(��rli� i'►'�N 55�t-�5 <br /> Phone (day): <br /> Address: 2(bt� S' W 2� City: ���.rc� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �'liK� �}..:e.c.(Lw«;,j„ <br /> Phone (day): ���Z-��(p -l�1 Z (.� <br /> Address: i Z - n „ ,,( T Cit : ��,(s= ,z:� ZIP: <br /> Email and/or Fax: ���,�� �,, � y, �„� �� <br /> PROJECT INFORMATION: Description of pro�ect: z�k- «�c,�.�+- <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <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 <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) Q Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.mirnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ (� �c%�; <br /> Last Updated: January 2015 <br />