Laserfiche WebLink
� � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: / —�J�7 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —/7/ <br /> StreetAddress:' Received by: <br /> y� `�' 2750 Kelley Parkway Plan review fee: '� �7// <br /> tq �,L Orono, MN 55356 a0/3 —DYJ3 7 <br /> '�B5 H OC� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �;S(� � 1.•(.,-J3 <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: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a specia/event permit is nsquired with Police Department and City Council approva160 days prior to the event. Shuttle bus se►vice will be <br /> required unless applicant demonstrates s�cient on-site parking is available. Non-pemiitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��'..�'1VAy� P�OPtS' I�Lri�� <br /> State License# �p�,��+-�� Expiration Date: ,�� �`�� <br /> Phone: cell office <br /> Mailing Address: ��(Q� �-r5,� �in.r'� /'�� ,��G City: rt�,i �p ZIP: �3"�7Z <br /> Contact Person: ���y� �'„n� ,•�v,a r� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �a ��,�hc�+n �fUlr 1�,�i �C�r� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �o�.�„ �r��.�sr;.r, <br /> Phone (day): �'�( Z ,� Q�g� <br /> Address: ►y ,� �q��•,�� ;;_� Q.1. P,.c.� City: �--�h.� ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEE FORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Ci : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: ` � .r"` <br /> 1.Type of Froject 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑ Residence <br /> �Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with � Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may also require ❑ Commercial � Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ��a��_� �i�2r' ❑ Private Vb'ell <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (SpeCify) �+ ��� <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n n e h a h a cree k.o r <br /> Estimated Construction Valuation (excluding land) $ q. � � <br />