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CITY OF ORONO 3� <br /> BUILDING PERMIT APPLICATION /• <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323.0 •� Date received: <br /> �nStreet Address:" Received by: <br /> �� 0 �. <br /> dl� <br /> tiF L� 2750 Kelley Parkwa� Plan review fee: a <br /> l�KESHO�� Orono, MN 55356 <br /> Main: 952-249-4600 <br /> Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us EW l- C•dt/ <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: 46, 5 5 "e '` r� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes KNo <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: PA U ^e0n (mit -rrc�G �l <br /> State License# C. 19--.S 0 Z 6 Expiration Date: 7r,17 ze7l 3 <br /> Phone: (cell) Z_ (o �� :)-C (office) <br /> Mailing Address: C S© Zr 5.on f-t . Ci : != c n ZIP: 5-14 Z <br /> Contact Person: ('S1r Applicant is: ontrac ,/ Homeowner (Circle One) <br /> Email and/or Fax: ,ei -ee- I . mv✓� <br /> PROPERTY OWNER I FORMATION: i q <br /> Name: tl'l�-ic k r- <br /> h�� <br /> Phone (day): &( 2.— Z 1 C9 6y-� <br /> Address: o L—D Che Cit : ne CY C"; ZIP: � 6 <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATIO <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 /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ essory Bldg./Garage <br /> El Addition attached garage Deck El Public Sewer <br /> E]Accessory Building El Single Family with Office/Commercial <br /> ocation detached garage El Residence El Private Sewer <br /> Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �X(ytjh t'_ ❑ Public 4-feet or greater El Public Water <br /> "Any earth movement m y 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) $ , coo <br /> Last Updated., January 2015 <br />