Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION ��•�'� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: sh I 0 oc)(Q(p <br /> VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: (D <br /> Street Address:' <br /> 2750 Kelley Parkway ��� �`� eview fee: <br /> egkFSHO�B EQ' 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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: ZS 70 e-lbup <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑ Yes 0 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: U Atls �/G <br /> State License# Expiration Date: 3 <br /> Phone: (cell) (0123 ala- g3 (office) Z-qi(O -- Y71 <br /> Mailing Address: i/ pra City: R <br /> Contact Person: L+4>�- ZIP. � 7y <br /> LI�'f5 /!V Applicant is: ntractor / Homeowner (Circle One) <br /> Email and/or Fax: 6-6 2IAI Ace-.COAA <br /> PROPERTY OWNER KATION: <br /> Name: y- 46111n/ L,%r10 qVir-R-- <br /> Phone(day): - 7 <br /> Address: '20 -_X b Cit &i (0 ZIP: <br /> Email and/or Fax Af414- <br /> ARCHITECT <br /> 1LARCHITECT/ 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 ConstructionWater Supply <br /> J�Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation D detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) Multiple Family/Condo ❑ Retaining Wall(s) <br /> 2t Adc. ❑ Public 4-feet or greater ❑ Public Water <br /> "Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review& permits. ❑ Industrial ❑Warehouse <br /> El Private Well <br /> Minnehaha Creek Watershed District(MCWD) ElOther: (specify) <br /> 15320 Minnetonka Blvd ( p ) Other(specify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehaha2L2gk.org <br /> Estimated Construction Valuation (excluding land) $ ZZ <br /> Last Updated: January 2015 <br />