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. . l�9. �/ <br /> CITY OF ORONO �/ <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: l ,`"J ' (/ci � <br /> O PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: l� <br /> Street Address:' I� Received by: <br /> y�, G� 2750 Kelley Parkway �j � Plan reviewfe : �,,�Uv 7 <br /> lqkESH��� Orono, MN 55356 r � /„ �i�I �� <br /> Main: 952-249-4600 Total Fee: ��� �r� (J <br /> Fax: 952-249-4616 �vw�v.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: �� ��/ G � Ll G �'���' �-� %u ����� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil/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: �5��G��/�- cF' iz C'C���h'( o�ul�--D��i'J i-�.. <br /> State License# Expiration Date: <br /> Phone: (cell)(o�Z� Z � �� office � ;L Y�� ����G ' <br /> Mailing Address: �=l'cj �1..�/.}S6-��� � Cit : ��/ �i.� ZIP: S� > � <br /> Contact Person: � /,<J��� S�y� � C�c�,G- Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: C�-�'�c� � Siy�vGr^��, , ���� <br /> PROPERTY OWNER INFORMATION: <br /> Name: fjf�J i�� fi�l72�� I-� <br /> Phone (day): <br /> Address: %��/n G� l.t /-��L City: C�' f�d��'�% ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: —�� �JC���%' ��G'�L''//��' C�u�� C��'�� <br /> Phone (day): lC ` -' <br /> Address: v - � � � �-�,; '�-�eii d�/1 Cit : �Z,L%�;�'Z�LF ZIP: �`�� � <br /> Email and/or Fax: ��` �� � L ���-�L�� , ��, <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 Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑ Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> � Relocation r�ak��n�>t;� i detached garage ❑ Residence ❑ Private Sewer <br /> Other: (specify) f6i�r_S</U�'lyl f�Lt ❑ 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 /> Estimated Construction Valuation (excluding land) $ �,.3, S l`� . `� <br /> Last Updated: January 2015 <br />