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<br /> ` CITY OF ORONO
<br /> BUILDING PERMIT APPLICATION
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> �O� Mailing Address: Permit number. p7���7-��7j�
<br /> Q PO Box 66
<br /> Crystal Bay, MN 55323-0066 Date received: � 7 / 7
<br /> �, � Street Address:' _•--- � �
<br /> Received by: r��
<br /> ��. G 2750 Kelley Parkway t��{, Plan review fee: v�,/. 5 � �
<br /> Cy �. ` Orono, MN 55356 �C_1(� l5 �5 �
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<br /> Main: 952-249-4600 Total Fee: � -/?--��- -- " ���
<br /> Fax: 952-249-4616 www.ci.orono.mn.us `3 �.:�., , �?„�
<br /> This application form must be completed in full and all required information must be submitted. ��5�; /-��
<br /> Incomplete applications will be returned. (Please print)
<br /> GENERAL INFORMATION: �.
<br /> Job Site Address: ,�S c`r0 S}� ��.r��,�J�. �c� , S�;1 c�.s 11� i3o�� �p /:30�3
<br /> Will this be a Parade of Homes, Remodelers Sho ase Home or other Display Home? ❑ es �No
<br /> /f yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service�il/be
<br /> required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: �4r�;e�s $C"5?S �. L.�_
<br /> State License# —� Expiration Date:
<br /> Phone: (cell) (o��- 3G�3-33,�1 (office)
<br /> MailingAddress: �Ile 't\�` A.,�, .ky. City: ��Dk��� ZIP: S�3y3
<br /> Contact Person: p�e7C �;o�.�}s Applicant is: Contractor / Homeowner (Circle One)
<br /> Email and/or Fax: ��Qx � �.,�d1�,�,s �c,���
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<br /> PROPERTY OWNER INFORMATION:
<br /> Name: USc,ra.ts ���i� 1�..L.G=. ^ r1\g-,c Ucor��+
<br /> Phone (day): (�,�a_ 3(�,3_ 3'3�\
<br /> Address: �-I10 I►�" A-,,r, Sa. City: }N��k,�i z�P: 5s"3�3
<br /> Email and/or Fax _ c�\e..,c ��_ r►,ib1�,,,a�iws ,c�r�
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Name: l.�i�k�i A►��:�����s
<br /> Phone (day): �js�'� _ `�y 1 - �C:�
<br /> Address: /s- ,t;,,,� y�}.,P_ ,t,�,. City: /-/op/�;�f ZIP: 5'S3`l 3
<br /> Email and/or Fax: cS I n � w�ik.�s�r<.a,. catY.
<br /> PROJECT INFORMATION: Description of project:
<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 Famify with OfficelCommercial
<br /> ❑ Relocation detached garage �] Residence ❑ Private Sewer
<br /> � Other:(specify) ('P�,A�1 ❑ 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 ❑ Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(speCify)
<br /> 1,5320 Minnetonka Blvd
<br /> Minnetonka,MN 55345
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.or
<br /> � � n �
<br /> Estimated Construction Valuation (excluding land) $ __�� b�`'" ' � ECEIVED
<br /> JAN 1 � z017
<br /> Last Updated: January 2016 CIl'Y OF ORONO
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