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, � <br /> CITY OF ORONO q� <br /> BUILDING PERMIT APPLICATION ff'� (�(� �,�Z� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: a��"7' �/ <br /> � l VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ���3� <br /> StreetAddress:' �,��,1 I Received by: m� <br /> ti� G� 2750 Kelley Parkway ��„ Plan review fee: �� Jr <br /> �.y �. Orono, MN 55356 �� <br /> kESH°�` Main: 952-249-4600 Total Fee: �����D/�7 <br /> Fax: 952-249-4616 www.ci.orono.mn.us �Q)�-� � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �(:> � 5�,�� �� , �, (U���u <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <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: ���i`� (.[Z�$� f k c.-��„�c L� ���- <br /> State License# t Expiration Date: //l 2�r� <br /> Phone: cell ;, - - 3 office s'Z- �(s' p <br /> Mailing Address: -7 7h �L �_ Cit : - ,� ZIP: - 7 <br /> Contact Person: � c� Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: ,� � ,�, ���„�,,,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: /l'1 � �.l �i� �� � <br /> Phone(day): � Z ^- -. - <br /> Address: Za� � s�;,,� (�.�.c ��. City: U�c:�� ZIP: ��� <br /> Email and/or Fax <br /> ��� <br /> ARCHITEC /ENGINEE NFORMATION: <br /> Name: • �• H�.c, � ,. <br /> Phone(day): � 1Z-- -- �7 2._ <br /> Address: � �J�J �J,I �� t�_�.�.lS 17r' City:����!`�.,�'�^ ZIP: S-� 3 S'� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction �ingle 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 /> �ther. (specif ) {' ���T`�+�{' ❑ Multiple Family/Condo etaining Wall(s) <br /> �t;� i„ I-� �� ❑ Public -feet or greater ❑ Public Water <br /> **Any earth m v�m�nt ma�als�f 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 <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> ' J� �� <br /> Estimated Construction Valuation(excluding land) $ �v� D v=� <br /> NOV �� '� 1U i7 <br /> Last Updated: January 2016 CITY OF ORONO <br />