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i <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION 3 (o <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,O Mailing Address: Permit number: ,U91 -7 <br /> V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 11-b9-1 -7 <br /> Street Address:' <br /> Received by: <br /> s� L` 2750 Kelley Parkway Plan review fee: J-�O zl. <br /> t�ktsHOOrono, MN 55356 a(J/ _017lOJ~ <br /> Main: 952-249-4600 Total Fee: C <br /> Fax: 952-249-4616 www.ci.orono.mn.us J <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: Ab �fionyti,t,, off, �.Ov�o, �.�rKiC, M IJ �jjp <br /> Will this be a Parade of Homes, Remodelers Showcase Wme or other Display Home? ❑ Yes No <br /> ff 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'sNFORMATION: <br /> Name: - K <br /> D1-in rAe.,-- ✓ $ <br /> State License# �,M1Whq Expiration Date: 'tj-Zp� <br /> Phone: cell office Z• -910 <br /> Mailing Address: 1 City: ; ZIP: <br /> Contact Person: Applicant is: n rac od Homeowner (Circle One) <br /> Email and/or Fax: LLS h , II�(.A Stm4,[�m <br /> PROPERTY OWNER INFORMATION: <br /> Name: 3 VLA r C V1 WOj <br /> Phone(day): (NZ-�IIL' '1'bL►g <br /> Address: City: ZIP: <br /> Email and/or Fax 17 A61. [tin <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: t; -3. <br /> Phone(day): <br /> Address: -Lis Avt. N City: ;VJV-#Cp 14ZIP: <br /> Email and/or Fax: [b11�y i <br /> PROJECT INFORMATION: Description of project: IIS <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction ASin le Familywith ❑Accessory Bldg./GarageWater Supply <br /> Addition attached garage [] Deck ublic Sewer <br /> El Accessory Building ❑ Single Family with C1Office/Commercial <br /> ❑ Relocation detached garage gResidence ❑ Private Sewer <br /> ❑Other:(specify) ❑ 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 XPrivate 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 RECEIV <br /> www.minnehahacreek.or <br /> 66 <br /> Estimated Construction Valuation (excluding land) $ • N(}I/ a <br /> CITY OF OPONID <br /> Last Updated: January 2016 <br />