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.it <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: - 7 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 9-17-1-7 <br /> Street Address:' Received by: /1L N M <br /> 2750 Kelley Parkway Plan review fee: .00 <br /> !q'�f S H� 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 informatioA must be submitted.QJ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 7�-c —1 C,uti'c� /ZEA h,�'A/ <br /> Will this be a Parade of Homes, Remodelers Showcasd Home or other Display Home? Yes ❑ 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: P(:,, 1 C5 `1 V i <br /> State License# ( Expiration Date: 76i? <br /> Phone: cell office <br /> Mailing Address: S Ai .vCit : i� o2-u ZIP: <br /> Contact Person: I Ce &,,(ct CaA- Applicant is: Con ractor / Homeowner (circle one) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: / <br /> Name: <br /> Phone(day): <br /> Address: -1 (�C) I u r`��w q (Zdl City: r,0 ZIP: S S <br /> Email and/or Fax K c-t -h 0y\c r\2 c l[ 0 , (. �c�-• <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 'b%P1�,,.n r1G 4 �e s-) <br /> Phone(day): -7 L 3- -7 kC — act�I <br /> Address: 't 1 00 i3� 1 h r�c,rcA Sfi tJ t-- City: IS� C4-, r.e ZIP: . <br /> Email and/or Fax: S v P F c �, _ (Q--, <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ��� Water Supply <br /> [New Construction ,A Single Family with [J Accessory Bldg./Garage <br /> Addition ttached garage ❑DeckPublic Sewer <br /> ❑Accessory Building [:1Single Family ' , ❑Office/Commercial '< <br /> ❑ Relocation a ched arae (R'Residence ❑Private Sewer <br /> ❑Other:(specify) ❑Multip a amity/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:(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 /> $ RECEIVED <br /> Estimated Construction Valuation (excluding land) L <br /> AUG 17 2011 <br /> Last Updated: January 2016 CITY OF QRONO <br />