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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR IVEW STRUCTURES OR 14DDITIONS <br /> �O� Mailing Address: Permit number. ( , � `�-- " <br /> O PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: '�Z ' <br /> StreetAddress:' �j" � Received by: �_S ��, � <br /> .� �. � d � ��� z � L (., <br /> y�, �G` 2750 Kelley Parkwa G� - �Plan review fee: a C ` �/O <br /> t�'FESH�� Orono, MN 55356 '�(� `� �'S0 y_Z <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 �ro�wu:�.ci.orono.mn.us � ✓ �,r�j la/� j��, <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: L " f �' ��J)t Gv�l /�j�, d �, <br /> Will 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 approval 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: .�'.� n�>S Gvw�%Ft�o�i i�N ,LN"�. <br /> State License# /S`/ 3 Expiration Date: �/�� � 2 e�i�- <br /> Phone: (cell) G'/2 � �//;�--- � 7��Z.... (office)�}1"L -�yG '� �3�'7L <br /> Mailing Address: �'y s` `�,n �/'Z i,r�'�ti �.vlL Cit : �� � ur..�,,ZIP: >"S'��,� <br /> Contact Person: �' %��llZ /t �✓S Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: s f�l��/S �� /�i�riivj,Qi� �c//3%, /1/rz! <br /> PROPERTY OWNER INFORMATION: � <br /> Name: /,/}dt2 GcJi f'J 3 o N' <br /> Phone (day): ' �.. � "3 S(o' � �' S/y Z <br /> Address: (9 1J �,vv�► Cit : B/lOi✓tJ ZIP: � � �� / <br /> Email and/or Fax <br /> ARCHITECT/ NGINEE INFORMATION: , <br /> Name: ` ��iar.e�l !e-�v' ►� /-�-T,$C�G//,%/� .vc , <br /> Phone (day): % � 3� -- d�Gy �- �F`��Z- <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <� --�t � CpC �� `� �� �''''��t <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage isposal 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 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&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 in nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ '7 f rl'/`�a ad <br /> Last Updated: January 2015 <br />