Laserfiche WebLink
S � o ` *"- 2 o <br /> v <br /> • * � �,Ft�` CITY OF ORONO j <br /> ve BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: �2 0 <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> � Street Address: <br /> Received by: 90 <br /> y� L 2750 Kelley Parkway Plan review fee: <br /> I�kESH09- Orono, MN 55356 �,�I <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: 75-5— <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes F24 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: Co:�,� —+ANG <br /> State License# TSG 1!S-7(oCExpiration Date: O <br /> Phone: (cell) (office) <br /> Mailing Address: M35' S.. <br /> City: ZIP: SS3 <br /> Contact Person: ' iijApplicant is: on c or / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFQRMATION: <br /> Name: ,\ <br /> Phone(day): <br /> Address: 75S 'j�„��c,Q J City: OKouv-p ZIP-5S-35--L, <br /> Email and/or Fax <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 /> [INew Construction Single Family with ElAccessory Bldg./Garage Water Supply <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation �) detached garage �91 Residence ❑ Private Sewer <br /> ❑ Other:(specify) Tres ❑ 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 <br /> El Private Well <br /> Minnehaha Creek Watershed District(MCWD) Eleci Other: s <br /> 15320 Minnetonka Blvd (specify) E] Other(specify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahapEggk.org <br /> Estimated Construction Valuation (excluding land) $ �� • �J <br /> Last Updated. January 2015 <br />