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� CITY OF ORONO 'r, �/0. 3 � <br /> - BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number. �._��-'/�-� �>�� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-006����+�` Date received: ��' ! `�—� So <br /> �; <br /> ,� �, Street Address:' � ;I � �' - <br /> y�, G� 2750 Kelley Parkway 1r�-� � I n review fee: �O — U � <br /> `qkESH��� Orono, MN 55356 ,� <br /> Main: 952-249-4600 Total Fee: !�� �%' [�� <br /> Fax: 952-249-4616 �vev����.ci.orono.mn.us '' � � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications witl be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: /is Sv�Z� I,�� o fz-c.�✓� <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. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAryT INFORMATION: <br /> Name: ��Nuw�c:S '�C <br /> State License# �. 5`����3 Expiration Date: 3 Zo r� <br /> Phone: (cell) (�iz-23g•,�,Sz (office) — <br /> Mailing Address: S�`� ���� 2n Cit : ZIP: s53�t5 <br /> Contact Person: ►ML��c,� Applicant is: ontra / Homeowner (Circle One) <br /> Email and/or Fax: R���"�5�-►4 �I� C��^"I��.co� <br /> PROPERTY OWNER INFORMATIq,N: <br /> Name: �t.���ltL- ��C��►-� <br /> Phone (day): C,tZ- ti i`i -5�Z7 <br /> Address: /f5 S�ti(N �� City: ��''A ZIP: �533'i <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : 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 /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation (� (� detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) `KF.f'�3C:L(�f�'(f� ❑ 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 <br /> ❑ 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 /> � <br /> Estimated Construction Valuation (excluding land) $ ��� " <br /> Last Updated: January 2015 <br />