Laserfiche WebLink
CITY OF ORONO � <br /> BUILDING PERMIT APPLICATION � �99 9 Z� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: <br /> �Q�O Permit number: /F'S—(�D/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'��� <br /> � ,, StreetAddress:' Received by: _�1�� d � <br /> y�. G� • 2750 Kelley Parkway �� Plan review fee: 9 �• !� <br /> `RKfSH��� Orono, MN 55356 ��� � 8���7� <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be return+ed. (Please print) <br /> GENERAL INFORMATION: D <br /> Job Site Address: Q q u�oDd <br /> Will this be a Parade of Homes, Remodelers howcase 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. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _ �q✓( So�2ivsPiv CBNs�"�'�o�v ..�n.c, <br /> State License# �L ���g Expiration Date: j-3►-�0/� <br /> Phone: cell � o�ce <br /> Mailing Address: S q Cit : / ;v ZIP: <br /> Contact Person: �,� m �/ Applicant is: o / Homeowner �ci�c�eone� <br /> Email and/or Fax: br��aN �dre.vs�.�rn�v � a wcq��l .Lo,+� <br /> PROPERTY OWNER INFORMATION: <br /> Nams: �c,� L.aae/�s�`�o�n <br /> Phone(day): ���y �_� �_ <br /> Address: yif�2S W Sa?�oI S f�^PC7` City: �o�(�;vq ZIP: ��y�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Ph;11�.o Soh,vson/ <br /> Phone(day): _ , <br /> Address: _ �(� 3�!� l�dt. dUol�� Citv:/'/�S� ZIP: ,�,�o?y� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal8� <br /> Water Supply <br /> ❑New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck [�f Public Sewer <br /> ❑Accessory Building � Single Family with ❑Office/Commercia� <br /> ❑ Relocation /� /� detached garage � Residence ❑ Private Sewer <br /> g]Other:(specify) 1'(Y./►tOdEt� ❑ 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&permits. ❑ Industrial ❑Warehouse <br /> ❑ 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: 952-471-0682 <br /> www.m i nnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ l�Oj�4 R�e��n <br /> FEB 2;4 2��8 <br /> Last Updated: January 2016 <br /> �OIS ORONO <br />