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. � <br /> � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> %f ��p�\,. Mailing Address: Permit number. " ��/ 7-G'(i'� <br /> /� �"` `V�� PO Box 66 � ��7 <br /> �� Crystal Bay, MN 55323-0066 Date received: '�- <br /> �� i Received by: �� y � <br /> ' Street Address:' <br /> ���?, ��� 2750 Kelley Parkway Plan review fee: ��J��, o� <br /> � '� Orono, MN 55356 . C"`�-�_ ��� <br /> `9�FSti° �/ Main: 952-249-4600 <br /> -- 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: �">�� ..� <br /> Will this be a Parade of Homes, Remodelers Showc e Home or other isplay 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: C��� J_-{? c L �1.� T��'�C �%u�`� <br /> State License# �i C- c.�j���� Expiration Date: /SrtA-,��f�- ..�0/9 <br /> Phone: (cell to�L - c� - ' .G� (office ' �-_��3-�3�.5 <br /> Mailing Address: j�� - � �,��'N- ,�'� Cit :�/1 '�ZIP: �5_, <br /> Contact Person: /S�!/ K' /�}� [t�S,qGt=�r �"�l Applicant is: n rac o / Homeowner (Cirde One) <br /> Email and/or Fax: �� ��p� ���/� �1� �{;]'o;t,t fF�S „ �t�M <br /> PROPERTY OWNER INFORMATION: <br /> Name: �f�-�� ��'i- G� <br /> Phone (day): (p/L— �7c� -- 7`f (� <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 ❑ 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 8�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd ��-"7 f}�� �'��� <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� � � <br /> Last Updated: January 2016 <br />