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CITY OF ORONO <br /> _' BUILDING PERMIT APPLICATION <br /> '� FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,. Mailing Address: Permit number: � � <br /> 1 VO P�B�X 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> y �, Street Address:' �r d ,�L c�� Z� Received by: :S �. � <br /> �, G� 2750 Kelley Parkwa C� �P�n review fee: � . '�/O <br /> �'�kESHO��' Orono,MN 55356 ��b <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: - Z .s-" � �� 6rjr�o� l�f�, p� �J. <br /> Wiil this be a Parade of Homes, R modelers Sh wcase Home or other Display Home? Yes No <br /> If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service ii!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: ,S' R S Gv�.� '^Rdci ioN ,LN'�, <br /> State License# /S`/ 3 Expiration Date: � 2 0-� <br /> Phone: �cell) G/Z� y/ � (; 7�Z (office)q1"L ^y y6 ^ /3'?Z <br /> Mailing Address: �'y s` '�n �/2 i,tJo GL Cit : G�/�." j �� IP: �"y'S p� <br /> Contact Person: 5' /� lz /t v� Applicant is: Contracto / Homeowner �ci��ie o�e� <br /> Email and/or Fax: t��! �/lviv ��c L /Z%, /1/ <br /> PROPERTY OWNER INFORMATION: � <br /> Name: �/�r/�2 GcJ��'J s 4 N <br /> Phone(day): (>l L - '3 S G � �' �/�/Z�- <br /> Address: �2 y .s�j�jPJywval,�/ZJJ City: �/POi✓O ZIP: �.� � �'/ <br /> Email and/or Fax <br /> ARCHITECT/ NGINEE INFORMATION: <br /> Name: �j�d!y! !E�O ►�- /.1.�,gOG/Al� 1�vc . <br /> Phone(daY)� / - 3�1 - 3�G y � .rfi yZ- <br /> Address: City: ZIp: <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 Dtsposal 8 <br /> Water Supply <br /> �New Construction ❑ Single Family with �Accessory Bldg./Garage <br /> ❑Addi6on 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 4feet or greater ❑ Public Water <br /> ""Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District MCWD ❑ P�vate Well <br /> ( ) ❑ Other:(specify) p Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Constructiorr Valuation(excluding land) $ � f^�� � <br /> Last Updated: January 2015 ' <br />