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. ,� <br /> � CITY OF ORONO I �?-�, �� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: l Permit number: � �p -d s <br /> PO Box 66 �(�,,� � <br /> Crystal Bay, MN 55323-0066����1` Date received: � lY�l �o <br /> Sfreet Address:� <br /> Received by: �� <br /> y `� 2750 Kelley Parkway Plan review fee: , �s <br /> F <br /> tqkfSH��� Orono, MN 55356 � !(P Q/ S� <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: I'L� c� SPt2vc,C P�-- <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 /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: I� vt�iD� L�-C� <br /> State License# Expiration Date: <br /> Phone: cell �i 52- S�tc�- 1 So office <br /> Mailing Address: 3 ZIP: 0� <br /> Contact Person: J c�l�� Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: �ti,� � .,� ,onM�1� Gb� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �,,,, C Pw�. �..,,.J� A�re� C, �°�.cas�,. <br /> Phone (day): <br /> Address: ��0 5,�tv�.� Ciry: f�,,.,�,\ ZIP: S5 U <br /> Email and/or Fax �rU Q V� �„ i 0 I'1✓y u Y1• CAYV�t �� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �i�K�� De��r Gm,,o <br /> Phone (day): ��"��=- 9�z ti�3-�»� <br /> Address: �oi �� I�Ic�. s� Ciry: tik,,,,�.��_ ZIP: ss--391 <br /> Email and/or Fax: _ �oY,r, �i o,�ek�v,d,�� Qt,����.�<,,,., <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 /> ddition attached garage ❑ Deck ❑ Pubiic 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&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 D <br /> Estimated Construction Valuation (excluding land) $ 2(�(� ��� <br /> _ �f11� <br /> Last Updated: January 2016 C�� ��� �-���������'��� <br />