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CITY OF ORONO <br /> �' BUILDING PERMIT APPLICATION <br /> •' FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: Permitnumber: � - (�� I� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �1 I 1 I <br /> � ,, Street Address:' <br /> Received by: IZ� <br /> y�, G� 2750 Kelley Parkway {(� � �qf�� r plan revie , feae: <br /> ��'�ESH��� Orono, MN 55356 • <br /> Main: 952-249-4600 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: `�j�j�j ��,��t�E y7�wE <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display 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 su�cient on-site paricing is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Ca2�,v- LAVr�r�, /�,c• <br /> State License# Expiration Date: <br /> Phone: (cell) `s]. ?ie�, . St�1 2 (office) C�$1- l038. yv�o <br /> Mailing Address: 29CoS `�ari-r�c� Q. Cit : ��, . F ZIP: SS 113 <br /> Contact Person: ��� �,or...�p Applicant is: on rac / Homeowner (Circle One) <br /> Email and/or Fax: �,�,o nS �C,,c,¢t��,��av„r�. cawl <br /> PROPERTY OWNER INFORMATION: <br /> Name: L�,r� �EAt, L�sr,oT-C �{b�D,..�a,L� LL.0 <br /> Phone (day): �5 2 . � � $' . ZCot9(p <br /> Address: �/0� I,✓. SO"' �c�T City: �DtiN�a ZIP: SSyZy <br /> Email and/or Fax ��,,.��FE2• ltE�rT�L�'HI •Cor-1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �J}�E,�4 /0 n.r,�{tT�'�cs� <br /> Phone (day): ��I Z • ?�39 . �2S� <br /> Address: _�p �,rs)-�{ g'n+ c�,�zuE,� City:J✓���,N�,s P�,uS ziP: S�ya Z <br /> Email and/or Fax: �IAsvn� S� S,�tEA�r�s�c.�.i.CoM <br /> PROJECT INFORMATION: Descri tion of ro'ect: ����/� ��� L`r� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck �J 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 <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 />