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. � CITY OF ORONO �-��'C,r'�' l.T� BUILDING PERMIT APPLICATION �� FOR NEW STRUCTURES OR ADDITIONS A, Mailing Address: Permit number: OJ7—O J� � �O`VO PO Box 66 Crystal Bay, MN 55323-0066 �-) Date received: /l� 7"1 StreetAddress:' �`6 Received by: �T y�, �� 2750 Kelley Parkwa� �� Plan review fee: ��9� lRKESHO�� Orono, MN 55356 � o?d 1`7_b/J� D Main: 952-249-4600 Total Fee: � Fax: 952-249-4616 www ci.orono.mn.us I � 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: �,J 1C� � l��-Z..(��i�,�:.- ,��'�,;;��, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �-�1� ��►S'�'�^�...{�� State License# 2.. Expiration Date: d 3 /s/ Phone: cell . 2, �. �- � office f" Z- �%k'�—`C��/ Mailing Address: �7 !� � Cit : � ZIP: S "' Contact Person: � . -�. �1, ,P� Applicant is: ontractor� / Homeowner (Circle One) Email and/or Fax: , � . L,,, PROPERTY OWNER INFORMATION: Name: /1.1c�- t- zt-��/ �"�'��5��+��c,��l Phone (day): • 1 — �t �— 1 Add�ess: 2:>7v I,�ar� �:�L.. (�Jr- City:U`�-��s ZIP: Email and/or Fax ARCHITECT/ ENGINEER FORMATION: Name: -,��eha� � �,,,r� Phone(day): — � — ' l � �Ze Address: S'1� Cit : G. � (,^t ZIP: S� �J--�IZ� Email and/or Fax: � �Q.� �u�� .�,�j,-�• L;,....� PROJECT INFORMATION: Description of pro�ect: 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 �IDeck ❑ Public Sewer ❑Accessory Building ❑ Single Family with �+Office/Commercial �Relocation detached garage ❑ Residence Private Sewer Other: (specify) L 4� ❑ Multiple Family/Condo ❑ Retaining Wall(s) .r�S �, ,`�,� ❑ Public 4-feet or greater ❑ Public Water *'Any earth mov�men�may also require ❑ Commercial ❑Storage MCWD review 8�permits. ❑ Industrial ❑Warehouse �F rivate 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) $ ��U �:Q ` ' ` �� f:: r' ��ril Last Updated: January 2016 �ITY OF ORONO