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� CITY OF ORONO <br /> ; BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: � —�d� 'rJ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � ( � S <br /> �, ,, Street Address:' <br /> Received by: <br /> y G` 2750 Kelley Parkway �r fV1 Plan review fee: � <br /> ��'�kESH��� Orono, MN 55356 Tlw <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 wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ���� �h�-� ��� ��� <br /> Will this be a Parade of Homes, Ftemodelers S owcase Home or other Display Home? ❑ Yes No <br /> lf yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLlCA,NT� INFORMATION: <br /> Name: G����7'-�� ��S <br /> State License# O 31a.6o Expiration Date: 3 3 —� <br /> Phone: cell 6�L—?60-2��Z office <br /> Mailing Address: �9 � �en K�.� �- S� Cit : d ZIP: � Z <br /> Contact Person: :;� �,� z Applicant is: Contractor / Homeowner �c���ie o�e� <br /> Email and/or Fax: �f��-�='.t��,.�-l�J.«Sl3 �,/,�koo ��e,�-7 <br /> PROPERTY OWNER INFO ATION: <br /> Name: �� � (-� <br /> Phone (day): T6o - �lo - �o <br /> Address: d-16� l� �o Cit : C�/6K� ZIP: S��/ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: T���-��! L«+ <br /> Phone (day): �.<>3- y6y - � 'y r <br /> Address: I z�� �.� U=cs,� � .�t� _ Cit : ,sc��.� ZIP: �l� } <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ��Z�-�G ��� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Constructio� �] 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. ❑ fndustrial ❑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 /> vr_- <br /> Estimated Construction Valuation (excluding land) $ �1�, (`i�3C� <br /> Last Updated: January 2015 <br />