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� � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: 2-��� ��Zg� <br /> PO Box 66 <br /> , �� ���o Crystal Bay, MN 55323-006 �- Date received: � 25 / <br /> ��V Z� A(�� Received by: <br /> �, �� Street Address:' a <br /> �� " 2750 Kelley Parkway 'JI� Plan review fee: � <br /> �qK���o��" Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: �37, Q� <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: f��2°�� �� <br /> Job Site Address: ��� �}�pt(��pp� �, ���Ilf��'�.�� t�ltJ S53�t2- _ <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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO/�M�ATION: <br /> Name: �'OL\��/ I..OM�tJ\� <br /> State License# Expiration Date: <br /> Phone: _(cell) (office) �--a� -$(oa0 <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: �(,�. �J Applicant is: Contractor / Homeown (CircleOne) <br /> Email and/or Fax: n IG1�-.qleG�.SO'�l `CI'l 0�,��G�.V COM�GL,y�tGS• G�Yv'l <br /> PROPERTY OWNER INFORMATIO�: <br /> Name: �pL.1DKk�/ b'S�)LL1V�4tJ�S <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg. /Garage <br /> ❑Addition attached garage ❑Qeck �blic Sewer <br /> ❑Accessory Building ❑ Single Family with �"Office/Commercial <br /> ❑,�elocation n�_ detached garage ❑ Residence ❑ Private Sewer <br /> � Other: (specify) U'�ilt�£� E . ❑ 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) ❑ Other: (specify) ❑ 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 Construction Valuation (excluding land) $ l� `� <br /> Last Updated: January 2016 <br />