Laserfiche WebLink
` CITY OF ORONO �,55 5. 10 .l1 <br /> BUILDING PERMIT APPLICATION a5C. oi,k) <br /> FOR NEW STRUCTURES OR ADDITIONSill <br /> 14 <br /> - 0 V Mailing Address: <br /> PO Box 66 Permit number: Q 7-0J I <br /> Crystal Bay, MN 55323-0066 Date received: 1(4-c?;.-IT <br /> Received by: {` <br /> Street Address:' <br /> yF L� 2750 Kelley Parkway Plan review fee: 042 'telo <br /> A4-£sH430' Orono, MN 55356 2OL7.-Q0 3 t 1 <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: C! <br /> Job Site Address: Z 740 roc J'• <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 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 /> Name: N <br /> CONTRACTOR/APPLICAT INFORMATION <br /> :r) <br /> �` 1 U-t5; , t <br /> f <br /> State License# .6C39 OW I Expiration Date: 3(311161 <br /> Phone: (celp_ lit, - 241, (o 1?Z. (office) qSL•935' 4(1(09 <br /> Mailing Address: lslj Sk' 9.. Saves City: 64•-k4,1 ZIP: S3-3f3 <br /> Contact Person: , h uv', IN. Applicant is: 4 on races / Homeowner (Circle One) <br /> Email and/or Fax: d.an h. kulAdesi9nbvil- .Lo rt\ <br /> PROPNameERTY OWNER INF ZZ 10 v cl- Litwin f Acu-s Ayt/'an <br /> Phone (day): Q . 4 }f• 3 SL . <br /> Address: 2.21-0 FoX Sl, City: nam ZIP: 5. 3.5"6, <br /> Email and/or Fax 41,44110ra n C. kbl. (dv►-' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 /> ❑4ddition attached garage 0 Deckublic Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> O Other: (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 & permits. ❑ Industrial ❑Warehouse _-PrtGate Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreekurg <br /> Estimated Construction Valuation (excluding land) $ % 000 <br /> Last Updated: January 2016tiotxticradip_ V 4 Z b 14 <br />