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� CITY OF ORONO <br /> BUILDIIVG PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: , Permit number: �UL�O— �� � <br /> PO Box 66 Z <br /> Crystal Bay, MN 55323-0066 b Date received: ✓ '� �'� <br /> Street Address:� r�1��r� Received by: �( <br /> y�, G` 2750 Kelley Parkway �� I�10 Plan review fe : <br /> �'�kFsxo4`` Orono, MN 55356 �Ir�( � � . <br /> Main: 952-249-4600 Total Fee: ��� � � �/ <br /> Fax: 952-249-4616 ww•F:,.ci.orono.mn.us <br /> This application form must be completed in fufl and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �,1D� r�,�n�Y Q�,� (��L�,,� c�l� 1�/11u <br /> Will this be a Parade of Homes, Remodeler Sh�e Home or otl�r Display Home? ❑ Yes (�] No <br /> lf 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l�V�e �rti���,.�so�l <br /> State License# [�q�l '3�K Expiration Date: �- 3�-�(r, <br /> Phone: (cell) �� a, a o-� ��,� R (office) �i� � � y���q <br /> Mailing Address: w "- Cit : � � ZIP: <br /> Contact Person: yl��}� Applicant is: rac r / Homeowner (Circle One) <br /> Email and/or Fax: ��Q�� � �,�S..f.���.�;� t,U,� � �,�a;(. r, �K <br /> PROPERTY OWNER INFORMATION: <br /> Name: � c'c„n;.����,�,a..✓�r��S r�� <br /> Phone (day): �15� �{`7'� O$S� <br /> Address: Cit : c..� ZIP: �Cc <br /> Email and/or Fax - <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: a rq�n.t <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 q r f detached garage Residence ❑ Private Sewer <br /> '�Other:(specify) (��hM2��U ❑ 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 2015 <br />