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. • CITY OF ORONO �f D. 3 � <br /> r BUILDING PERMIT APPLIC�4TION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O/�� Mailing Address: � <br /> ` �O PO Box 66 Permit number. 0��j - � <br /> Crystal Bay, MN 55323-006 �� Date received: �P� ! `a-l (,o <br /> C �� I� Received by: <br /> � �, Sfreet Address:' <br /> y�. : 2750 Kelley Parkway � �� Plan review fee: p2� - U � <br /> ��kESH���G Orono, MN 55356 � <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: <br /> Job Site Address: /is Sv��� I,vG o Rr��' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> /f yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the evenf. Shutt/e bus service wi//be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��N�w�c.5 '�C <br /> State License # � $qo 1�3 Expiration Date: 3 �r� <br /> Phone: (cell) (�iz-23g•,1,SZ (office) — <br /> Mailing Address: S�y ��-Y-�� 2� Cit : ZIP: 5'S3�t� <br /> Contact Person: �^'�L�Lc�• Applicant is: ontra / Homeowner <br /> Email and/or Fax: `Z��"�MS�,� �j� �r�I�-i,ca� (Circle One) <br /> PROPERTY OWNER INFORMATIq,l�: <br /> Name: ����tC; ��C.��+-� <br /> Phone (day): (,tt• y i`i =5 Sz-7 <br /> Address: .. ��5 S+^�titT1 vG- City: ��'*'A ZIP� �533'1 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Emai� and/or Fax: <br /> PROJECT INFORMATION: Description of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New Construction �Sin le Famil with �Nater Supply <br /> g y ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑ Office/Commercial <br /> ❑ Relocation (� D' detached garage ❑ Residence <br /> ❑ Other:(specify) `KE,f'�Df3C:.L(�'({� ❑ Multiple Family/Condo ❑ Retaining Wall(s) � Private Sewer <br /> ❑ Public 4-feet or greater �Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: S eCi ❑ Pflvate Well <br /> 15320 Minnetonka Blvd � P �� ❑ Other(SpeCify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 7���^ <br /> Last Updated: January 2015 <br />