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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: <br /> Permit number: ✓w�P�O <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a Street Address:' C <br /> 9� G` 2750 Kelley Parkway � �`(' eview fee: <br /> ESHOOrono, 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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: Z-15-70 / D <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑ Yes No <br /> /f 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: ®GlT2)� 5 VZZAtlS /WG <br /> State License# IkA-2-11'2!17, Expiration Date: 3 17 <br /> Phone: (cell) (p(Z gb- 31;,3 (office) Z-q'0 - y7`7 f <br /> Mailing Address: i( 00 city: ZIP: 7^-2, <br /> Contact Person: AhRf5 /Al Applicant is: ntractor / Homeowner (circle one) <br /> Email and/or Fax: (c&4 /Al 4Vf}oc.•C0I-A <br /> PROPERTY OWNER INFORMATION: <br /> Name: 67e41_6_:2_ <br /> Phone(day): — 7 <br /> Address: 0 j, City: ,Lt1�lO ZIP: <br /> Email and/or Fax 77Ag &10 . <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: 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 /> ❑ New Construction gSingle Familywith El-Accessory Bldg. Garage <br /> Supply <br /> ❑Addition attached garage Deck <br /> El Accessory Building El Single Family with Office/Commercial El Public Sewer <br /> ❑ Relocation D detached garage ❑ Residence <br /> ❑Other:(specify) X0P1Fy7�A/,0 gel Multiple Famil /Condo Private Sewer <br /> —� p y El Wall(s) <br /> Ef a�1d ��� El Public 4-feet or greater El 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 <br /> Estimated Construction Valuation (excluding land) $ ZZ, <br /> Last Updated: January 2015 <br />