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, ��.CEIVED <br /> CITY OF ORONO MAY U �2n�7 <br /> BUILDING PERMIT APPLICATION C�T`( OF ORONO <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: Permitnumber: ��17—� <br /> PO Box 66 �� / <br /> Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' ------ �eceLed by: ��� <br /> ----_.___ <br /> y�, G� 2750 Kelley Parkway % Plan review fee: � �. 5 �'� <br /> t�kESHO�� Orono,MN 55356 �- -- -----_ �/7'��i � <br /> Main: 952-249-4600 Total Fee:� <br /> Fax: 952-249-4616 www.ci.orono.mn.us s' �f,(L, , 2 2- <br /> This application form must be completed in full and all required information must be submitted. ��,� ��,� <br /> Incomplete applications will be return�d. Please print) �-�'' <br /> GENERAL INFORMATION: ����? �G'1G����.-r�vL� iris,�?�� <br /> Job Site Address: r��� ,,���c�: 1�:.s�,�».i� Cs�,,�� �� ,k-� �CC'� - `�5.� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a specia/event permif is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 1���;N�-S �C:ti� L.L.C. . <br /> State License# Expiration Date: <br /> Phone: (cell) (�1 � -�i(c,,5 -• 3�� � (office) <br /> Mailing Address: �I�a i�t'' fj-o�,Sc � Cit : p k-,n� ZIP: S�_3�!3 <br /> Contact Person: �1��c ljc - � Applicant is: ntr�to� / Homeowner (Circle One) <br /> Email and/or Fax: C:.\c3.�,cQ id lo.�,dc;l�s.cc.�^'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: l�«�:�s ��:9�s �.�..c'. . <br /> Phone (day): �,17�� -3�='3 -3_iFa� <br /> Address: �! lo li *" P}�� . S�; CitY: }-�o,k:,;,� ZIP: 5:.53� 3 <br /> Email and/or Fax c�..�F�c� �+-�;�l\�.�,�..�:1 � tc . c c�e�, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,v�11;�s ��.�;}-,�}y <br /> Phone (day): q,�� - �-�_; �-3[�S� <br /> Address � ,S it;;n}�. �}��. �3o City: j-}�,��;�S ZIP: S�,�f.3 <br /> Email and/or Fax: d j p��_i.,�;\koS c�c� . C��ti. <br /> � <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Dispo::al& <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) C�r►,�h,�\ ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater �.Public Water <br /> **Any earth movement may also require Q Commercial ❑Storage <br /> MCWD review 8�permits. �❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ a ��, ��<>�"> C'%�j <br /> Last Updated: January 2016 <br />