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'� CITY OF ORONO <br /> . BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number. "V . g <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: '-2� �`� r <br /> � � StreetAddress:' �� �a ` Received b : �-4 <br /> y�, G` 2750 Kelley Parkway p� � I n review fee: <br /> `qkESH��� 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 �'-�-���h,t.�..�'�., "'�,�rZt V E <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f yes,a specia/everrt permit is required with Po/ice Department and City Counci/approva/60 days prior to the event. Shutt/e bus service wi//be <br /> required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: C�A2�.S�,.t � LAV�..a€r IN�. <br /> State License# � Expiration Date: <br /> Phone: cell " j. d E Z, office , la �3.QJ toot7 <br /> Mailing Address: �R�., � Cit : � � �� ZIP: ► <br /> Contact Person: Applicant is: C rac / Homeowner (Circle One) <br /> Email and/or Fax: ����'�C.,t2csaN�..av���.CoN <br /> PROPERTY OWNER INFORMATION: <br /> Name: L.e��r� �ao� —�-�oc..� r�.t�� f�rc • <br /> Phone(day): CjS�• 9/5: 2��Z <br /> Address: y lats �. �p"^" S�-��er City: ����A ZIP:�s�-{Z� <br /> Email andbr Fax j2�S� , c�.r��V��w�e,r{� L�(. c.��-�t <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �f vd �C!2�'-+-t Nl��f'�, <br /> Phone(day): (�-L_�y� . �2 !Qi <br /> Address: Id 50�'1'�-� �'i" ST . City: ��hN'�p A��tS ZIP:ss�'f�Z <br /> Email and/or Fax: .4 � � ,�.rt: � t . o t�1 <br /> PROJECT INFORMATION: Descri tion of ro'ect: �� ��� �� <br /> ����' <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 detached garage ❑ Residence ❑ Private Sewer <br /> Other: (specify) ��'�r�� ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> o�►L 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 />