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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � � ,�j � <br /> �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number. . -� / —�� � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �—�—/� —( <br /> StreetAddress:' \�N Received by: � `y � <br /> ti�, � � �� 2750 Kelley Parkway � �\�'� Plan review fee: �, <br /> � �' � Orono, MN 55356 / <br /> � 7—D/�� <br /> qKfSH� �� Main: 952-249-4600 � � <br /> �� 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. (P/ease print) <br /> GENERAL INFORMATION: , - -=1----�_ �����J`Zv �� � <br /> _... <br /> Job Site Address: � � v � �� -��`-� �� ^ <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 approva160 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/APP ICANT I FORMATIOI�:� /�� <br /> Name: � ti'����.n �`�u�` ��� uC <br /> State License# � Expiration Date: �7/� <br /> Phone: cell 'Z ?r /�d office � <br /> Mailing Address: :' ;.,� Ci � �� � ZIP: �'`` <br /> Contact Person: ,� t=1= Applicant is• ontractor) / Homeowner (Circle One) <br /> Email and/or Fax: ,,�t=� ��,+. mrk� -----��""� <br /> PROPERTY OWNER INF RMATION: � � <br /> Name: �'�� � /�V J �GCc'� <br /> Phone (day): (n <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER IN ORMATION: <br /> Name: �2� SC�� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: c � <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Dispos & <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 /> �ther: (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.m innehahacreek.or <br /> / ; / <br /> Estimated Construction Valuation (excluding land) $ J� d�� <br /> Last Updated: January 2016 <br />