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� � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: I . --GC�S <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � � 1 S <br /> Street Address:� ___-.--�_ Received by: <br /> � � __ __ <br /> ti�, �G` 2750 Kelley Parkway �r� Plan review fee: � <br /> tqk�SH� Orono, MN 55356 Tl�''' �. - <br /> � <br /> Main: 952-249-4600 Utal Fee: �aa'� ' S� ��� ,/�ofis <br /> Fax: 952-249-4616 www.ci.orono.rrin.us d � <br /> This application form must be completed in full and all required informafion must be submitte <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: , c-, <br /> Job Site Address: ����` -� ���-� �`��-�L'�� ���� � <br /> Will this be a Parade of Homes, Remodelers S owcase 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 ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: Gl'��-�':�� �,_�c;�� <br /> State License# - C� C.: j >,�L� Expiration Date: � - (T� <br /> Phone: cell ���---?6c)-Z�.�Z office <br /> Mailing Address: 5'-9 �-�' {�n�1�.a � 1�- S E� Cit : '��t�� ZIP: �`�1 � <br /> Contact Person: .,� �,,� Z Applicant is: Contractor % / Homeowner (Circle One) <br /> _.._.-- , <br /> Email and/or Fax: ��c�.-�-`-� � � lc��� S�3 ���' 1��� . ���7 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �.i � ,�- f.,� (- <br /> Phone (day): �6�� - Ll�J'.s - jp� ,. � <br /> Address: ��-16�� SJ� � i,ti`c� � � Cit : �`�%����� ZIP: �5��/ <br /> Email and/or Fax + C. W� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: T� '�t \2 � �.�._:� ;� <br /> Phone (day): �s �>�y`��f y . <br /> 1 <br /> Address: J Z"� .'-� V=cs,� � ,ti _ Cit : � '�,� ZIP: �l4 � <br /> Email and/or Fax: <br /> r� � �/�� �,;�t� � . <br /> PROJECT INFORMATION: Description of project: �-� ��- ��-` `� ����� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> � New Constructio „ �] Single Family with ❑Accessory Bldg./Garage <br /> � �-ti� �� <br /> Addition 1 � attached garage ❑ Deck g] Public Sewer <br /> Accessory Building � ❑ Single Family with ❑ Offi�;;/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 ❑ 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 /> �.�_ <br /> Estimated Construction Valuation (excluding land) $ �l�' �--v�% <br /> Last Updated: January 2015 <br />