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�Pd r4 is <br /> 4�P�r�s--f• 612 <br /> � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,1O A, Mailing Address: Permit number: <br /> r VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: — _ 1 -7 <br /> a Street Address Received by: <br /> .922 <br /> tiF L� 2750 Kelley Parkw 2,�� ' (� Plan review fee: c�(D <br /> �gKfsHOR�` Orono, MN 55356 <br /> Main: 952-249-4600 Total ee: <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. L 'IlZrJ <br /> Incomplete applications will be returned. (Please print) //7 <br /> GENERAL INFORMATION: <br /> Job Site Address: 0 2�p Townl!In6 Xcelcl <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/AP LIC,ANT INFORMATION: <br /> Name: .rl.t5 <2LAS0�. <br /> State License# Expiration Date: <br /> Phone: (cell) 763 3,EeG, 3q% (office) <br /> Mailing Address: 11.60 0 „l, c Rocca City: 0"V <br /> Contact Person: (?�rke, Applicant is: Contractor. Homeowne (Circle One) <br /> Email and/or Fax: �;e.l.�s�r�ft� nt;cdl �.nick <br /> v <br /> PROPERTY OWNS JINFORMATIOI�: <br /> Name. eS fa „sow <br /> Phone (day): _IG03 9-SC. SySi. <br /> Address: 11,C0 -rGL,r bn-c -.d City: OrICA 0 ZIP: JIN y <br /> Email and/or Fax ns� /!t1{Ul�i� ,,flpt- <br /> J � <br /> ARCHITECT/ENGINEER INFO�?.MATION: <br /> ,� L. , <br /> Name: /( I 't,r\, <br /> Phone (day): 00-Y• 11%qq <br /> Address: � c i; City: zip:5S573 � <br /> Email and/or Fax: ,td , eo,,,,_ <br /> PROJECT INFORMATION: Description of project: � --- <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ElNew Construction [Z Single Family with ElAccessory Bldg./Garage <br /> 1?-Addition attached garage N Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence Q9 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 />