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� <br /> , � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �A, Mailing Address: Permit number: ���� � � ���L'�`�� ���� <br /> � `VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � - /2 - � � <br /> .� y <br /> StreetAddress:' Received by: � � ; /-: <br /> y�, G� 2750 Kelley Parkway Plan review fee: , " ` '' '�eI ;� • , ��. l <br /> ��kfsHo�� Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: � � <br /> Fax: 952-249-4616 www.ci.orono.mn.us �� 7 � �� <br /> This application form must be completed in full and all required information must be submitted. � ���.ss i�-i - <br /> Incomplete applications will be returned. (Please print) � <br /> GENERAL INFORMATION: <br /> Job Site Address: {�����„�a�e� �s�nes5 ����C - o� SaC� �hc.�vwoo� 1�, <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 approval 60 days prior to the event. Shutt/e bus se�vice will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-pemritted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l�ocQ.ats �D�iB L.L.C.. <br /> State License# Expiration Date: <br /> Phone: (cell) (ola -3�3-33a► (office) <br /> Mailing Address: y t o )fi'- �,�, So. Cit : k' 1 Z�P: <br /> Contact Person: �� Applicant is: on ractor'�,4 Homeowner (Clrcle One) <br /> Email and/or Fax: w��X� ',d\�.� c.1�ss . ca �r • <br /> PROPERTY OWNER INFORMATION: <br /> Name: L.�. CC . <br /> Phone (day): � <br /> Address: H Ic� �\ � {��, So City: �!�{opk,ns z�P: 5"S3y 3 <br /> Email and/or Fax �� \ tG. , v, <br /> ARCHITECT/ENGINEER INFORMATI�N: <br /> Name: (��.\�C�s r�,'.^�c�ts <br /> Phone (day): 9�a- 9�i 1 � 8!v fo D <br /> Address: /S Ni��+L A.��. N, City: /-/n�k;,,. z�P: .�S3y3 <br /> Email and/or Fax: ����_�,a; ��cul a,r�l., �v,.. <br /> �— <br /> �(�'.`�, � � <br /> PROJECT INFORMATION: Description of pro'ect:��� ��'� !''��� �� � I ����� ��k. <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 Family with Office/Commercial <br /> ❑ Relocation �I�, 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 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑pther:(speCify) �Other(specify) <br /> 15320 Minnetonka Blvd �� <br /> Minnetonka,MN 55345 �Tf�r7' <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ , � ��� Od a, �p <br /> Last Updated: January 2016 <br />