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CITY OF ORONO <br /> „ BUILDING PERMIT APPLICATION <br /> �" FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: c�(�� �`� � O <br /> `VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ,R,eceived by: <br /> �, ,, Streef Address:' �-----�� �� <br /> S'�. : 2750 Kelley Parkway ��� � P an review fee: , �� � <br /> `qkESH���G Orono, MN 55356 �- ---�- ' ��- � <br /> Main: 952-249�600 -- <br /> Total Fee: <br /> Fax: 952-249�616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appllcations will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1�}go G R l� O«,a,e S�5 3 S�o <br /> Vllill 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 approva/60 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 /> CQNTRACTOR/APPLICANT INFORMATION: <br /> N�me: N Ar 5�m� w5 a�-r�c�— <br /> State License# Expiration Date: <br /> Ploone: (cell) (office) <br /> M�iling Address: City: ZIP� <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: Eri{sw G-ul6rwr�Sav�+ <br /> PMone(day): lp1'1 �3 09 • o I I�} <br /> Address: I�•f�0 GN-. lo City: p�..,�e Zlp: 5�53$�� <br /> Email and/or Fax ��A y Ib�•a�r,dsa►� C� q M►+w��. Go� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: N A. <br /> Phone(day): <br /> Address: City. Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: ,�/�' I��/ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewa e Dis <br /> 9 Posal& <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 <br /> ❑Other:(specify) ❑Multi le Famil /Condo ❑Private Sewer <br /> p y ❑ Retaining Wall(s) <br /> ❑Public feet or greater ❑Public Water <br /> **Any earth movement may also require ❑Commercial �torage <br /> MCWD review&permits. ❑Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:{specify) ❑Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Mi�netonka,MN 55345 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.mi nnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ -r,,'�OOp <br /> Last Updated: January 2016 <br />