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� , a <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Addness: <br /> �. .�O Permitnumber. /(� 'L�/S <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: �Z � <br /> .� Street Address:' - ' b : 1- <br /> y�r Lti'� 2750 Kelley Parkway ��(� ' � review fee: � . ��-j <br /> �'�kESHOR�` Orono, MN 55356 ;�.; <br /> Main: 952-249�600 Totat Fe : <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 ��,Qg�N f `�rj,1 V� , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e 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: CAr2.4So N—�v V/tiE� /NC • <br /> State License# Expiration Date: <br /> Phone: (cell)(�/. 1�02,, E3�o12, (office) <br /> Mailing Address: 29 1`� 2�--r�r �'Lva Cit :/l.v��'v��.c.r ZIP: /! <br /> Contact Person:� '�2��n ,St(ynNt,P Applicant is: ntr / Homeowner (Circte One) <br /> Email and/or Fax: r�/f��j S���LLSONLq�lµ 'G CO}�I <br /> PROPERTY OWNER INFORMATION: <br /> Name: 1,r� r., ,n �ve r� .�.(o�ra�, 1�c- <br /> Phone(day): �I�'j'2• 9/ _ 2��F Z <br /> Address: �1pQ �• Sp� t�,��- CitY: ��,v,o ZIP� �`j' �2�} <br /> Email and/or Fax �Z.��S �P G�u K�wc��7 L�`�C/ Go H � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv: ZIP• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition � attached garage ❑ Deck <br /> ❑Accessory Building �1��h/ ❑ Sin le Famil with ❑Public Sewer <br /> g y ❑Office/Commercial <br /> ❑ Relocation t,,�O�uN� detached garage ❑ Residence <br /> �Other:(speay) �(� ❑ Multi e Famil /Condo ❑ Private Sewer <br /> p1 y ❑ Retaining Wa�l(s) <br /> ❑ ublic 4-feet or greater ❑ Public Water <br /> *'My earth movement may also require �Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Qther:(speCify) ❑Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation(excluding land) $ 1�� Oao, <br /> Last Updated: January 2016 <br />