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CITY OF ORONO <br /> BUILDING / <br /> PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> t1 /� Mailing Address: Permit number: <br /> X01 �Ob f <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ,a Street Address: <br /> Received by: / �.. <br /> ti� L 2750 Kelley Parkway Plan review fee: <br /> IA �yG'S 3S <br /> l'9kESHO Orono, MN 55356 �y�V <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: q X <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 4No <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: 0.0111 <br /> State License# Expiration Date: <br /> Phone: cell - office <br /> Mailing Address: Cit K-,4 ZIP: / <br /> Contact Person: MOLD VOUN6.5 Applicant is: (Contractor3/ Homeowner (Circle One) <br /> Email and/or Fax: M 1{4't-Ly C JGt,.onc ceVST0A.ALT'/oN CaN► <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): _ <br /> Address: City: d12raN® ZIP: <br /> Email and/or Fax ('.�,SyN tti, b9M3 e •,Aa�oc, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: [� t <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 /> fX] Single Family with ❑Accessory Bldg./Garage <br /> ❑ Addition attached garage ❑ Deck <br /> ❑ El Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> Relocation detached garage ❑ Residence ❑ Private Sewer <br /> Other: (specify) _WIND GI&� ❑ 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) ❑ 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) $ 0 <br /> Last Updated: January 2015 <br />