Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: kpr, <br /> PO <br /> �s7 <br /> PO Box 66 2� <br /> Crystal Bay, MN 55323-0066 Date received: <br /> _ <br /> A ,, Street Address:' -------�--Fr��, Received by: <br /> 2750 Kelley Parkway ,zu f� —V� Ian review fee: <br /> l�kfSHO�� Orono, MN 55356 �:_c '- <br /> Main: 952-249-4600 o al Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us 5d . <br /> This application form must be completed in full and all required information must be submitted. 5 g j►S <br /> Incomplete applications will be returned. (Please print) 9 JJS(o <br /> GENERAL INFORMATION: <br /> Job Site Address: 75 20 <br /> Will this be a Parade of Homes, Remodelers Showcase 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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _TP-L�-► CC,= r UUM <br /> State License# Z Expiration Date: 3 AZ <br /> Phone: cell (BIZ. Sp office (L • Z /l <br /> Mailing Address: A T. VIT'C City: l''llKWt- 045 ZIP: O <br /> Contact Person: jDET-LD� C{�y t,4 Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ?eTEvL TIAL=5TL>ELUb �loNltr C <br /> PROPERTY OWNER INFORMATION: <br /> Name: - c? E7- &,C>.V 1-1 <br /> Phone (day): _763- z1q 3- 0 7 68 <br /> Address: 755 -T­0N kap/A MoD City: C�2C7 o ZIP' 5,535 <br /> Email and/or Fax JI3�D.�/N_t� Lae70r=►T-. CQ,.j <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: c <br /> Phone (day): &2- - ZO __ <br /> Address: -a-2-ey11 MAAE�? ,( IC- 12 City:Ntuule�5 ZIP: <br /> Email and/or Fax: G6-CL-1_ <br /> PROJECT INFORMATION: Description of project: _/ <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> XNew Construction El Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage Deck N�Public Sewer <br /> T&Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify)D�M r'i CAQ- ❑ 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: (sp ) El Other(specify; <br /> ( ; nw ecl <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) $ 57,QC0.00 RECEIVED <br /> JUL 2 6 2016 <br /> CITY OF ORONO <br />