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� �SC.f"U� t��,�,�.t� t°��i- CITY OF ORONO - - ��`�Y�`'�' �`'``� � BUILDING PERMIT APPLICATION . FOR NEW STRUCTURES OR ADDITIONS • � OA, Mailing Address: Permit number: 2 O 7 � � I �/ � f VO PO Box 66 Crystal Bay, MN 55323-0066 Date received: �- - -7—1 �7' � �, StreetAddress:' R �eived by: y�. G� 2750 Kelley Parkway D l� �Q�f I n revie fee: 36 'S(o • v� lqk�SH04�. Orono, MN 55356 Main: 952-249-4600 Total Fee: Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: �'1 So S N-Prpti'wvv n �p . , DQo,uo N� N 5�36�f Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Q No If yes,a specia/event permit is required with Police Departmenf and Ciry Council approva/60 days prior to the event. Shuttle bus service will be required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: 5'rc�n�Ewoo�p� `,L.L State License# (�� S9 �3 I S Expiration Date: Phone: (cell) (office) (��1- �L�..-y o00 Mailing Address: 1 F_ �r L�a. Cit : � r ZIP: � Contact Person: �on-tw�. -SvivES Applicant is: ontractor Homeowner (CircleOne) Email and/or Fax: �w�,�-,�cz STo�U�wc�vi0. Cov�a PROPERTY OWNER INFORMATION: Name: �rR�Tc.r}�►J �Nn 1--Y�rz S F�Mi.� Phone (day): (6 t�� 3��—S.'�.7 O Address: �oo � 1cLN6'S'`� !)2rvE� City: �p��/ �1R,tFZ�P: ST3�6 Email and/or Fax 6rc-r�.,Q-r a1+�Q oK.�,rs�o�n-;nr .cv� L�/c s�4.w� e,��'s�i�, ��c. � ARCHITECT/ENGINEER INFORMATION: Name: A�rLx,4,�oE�. (�r_�s..9n� G'u.o�o Phone (day): q�� - c..}73 - S'7 7'7 Address: p S?' ts/o Cit : fiYL��, ZIP: SS� Email and/or Fax: �Q y,.� � Q.LnxG.H n.r es:a.. aror�o . �o-,�. PROJECT INFORMATION: Descri tion of ro�ect: �l/�-P.c.c> o�l/Y\ 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply �New Construction [� Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck � Public Sewer ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage � Residence ❑ Private Sewer ❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater � Public Water **Any earth movement may also require ❑ Commercial ❑ Storage MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(speCify) 15320 Minnetonka Blvd Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ g�� , �� (� , � Last Updated: January 2016