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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION l <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: o^�/7— <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006 GfC�. Date received: �v '/�,� -�-7 <br /> Street Address: Received by: � (_ AIF <br /> tiF 2750 Kelley Parkway a,�o �� Plan review fee: P1503 - 5-5 <br /> !�kESHO��G Orono, MN 55356 iI1�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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 118S Toy%k,t%oc, FA <br /> Will this be a Parade of Homes, Remodelers Showcase 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: Kv�A ?U,'1 <br /> State License# C-3 10 1 1 Expiration Date: 3• ' 15 <br /> Phone: cell IZ.- 4 • office 11!;'2., 1735-• <br /> Mailing Address: Is—us— ' City: ZIP: 3 <br /> Contact Person: y- ApplicaContractor / Homeowner (Circle One) <br /> Email and/or Fax: K L kv tci l jhb u idsls:LD 44 <br /> PROPERTY OWNER INFORMATION: r <br /> Name: VC -V ,e !r irl <br /> Phone (day): 0 IL—7,0Z. <br /> Address: fj Wk City: for)o ZIP: Seo <br /> Email and/or Fax `��,,�;etMAr�Qrt-► a �1y/ Cd <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: II l <br /> PROJECT INFORMATION: Descri tion ofproject.- lWevi, (oho cY 054,w Wri� q <br /> 1.Type of Project 2. Proposed Use 3.Structure Ty0e 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with El Accessory Bldg./Garage <br /> ddition attached garage El Deck El Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ 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 ❑ 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) $ <br /> Last Updated: January 2016 <br />