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`' '''''� RECEIVED <br /> CITY OF ORONO MAR � 7 2017 <br /> BUILDING PERMIT APPLICATION C�-�y O�ORONO <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�\ Mailing Address: Permit number: b �'�� z�.J <br /> O� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —a1�—�� <br /> Street Address:' Rece ived_by: <br /> � ,, � _ — .- <br /> ,� 2750 Kelley Parkway � ,/ Plan review fee: JT t�' <br /> yF`�kESH���� Orono, MN 55356 �� ��'/�'('` � '7_� �� <br /> Main: 952-249-4600 . _ -_�— � <br /> - Total Fee: ���(-`�` 7 ---� � <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. ����� ,�.�� j7 <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: S(]a �� �p � ����rl�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or o�tN er Display Home? ❑ Yes �No <br /> ff 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 e <br /> required unless applicant demonstrates su/ficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: / /� <br /> Name: .�/rIC/v:; ���r7�7L/'(1C.r7ON <br /> State License# ����� �l, y1,/ Expiration Date: <br /> Phone: cell office - - 'L <br /> Mailing Address: W Cit : � � � i ZIP: � � DG= <br /> Contact Person: Q Applicant is: on rac or / Homeowner (Circle One) <br /> Email and/or Fax: t. , a U <br /> PROPERTY OWNER INFORMATION: <br /> Name: �i'' ���C�i� �� <br /> Phone (day): � - a "', � , � <br /> Address: f- • ,p� Cit : ONt� ZIP: <br /> Email and/or Fax � �.;d'. �' �vr✓l <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: � Cit : ZIP: <br /> Email and/or Fax: <br /> / n <br /> PROJECT INFORMATION: Description of pro'ect: • �-' �!/" �1 ,(� ��' J�)c�-�� C�J"C'_� <br /> 1.Type of Project 2.Proposed Use � 3.Structure Type 4.Sewage Disposal 8� <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) ❑ 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) $ �� Q�� � <br /> f ` <br /> Last Updated: January 2016 <br />