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i ��,.z,�t•-612i <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address. Permit number: <br /> 'VQ PO Box 66 T <br /> Crystal Bay, MN 55323-0066 Date received: 44 —Z <br /> A ,, Street Address:' <br /> Received by: <br /> 2750 Kelley Parkw 2 r j Plan review fee: c�(p <br /> `9kfSHO��G Orono, MN 55356 "1 <br /> Main: 952-249-4600 Totalee: <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: 0-KO To�onilne, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes EZ 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 LItrANT INFORMATION: <br /> Name: A,�o . <br /> State License# Expiration Date: <br /> Phone: (cell) 7La334C, :5 q516 (office) <br /> Mailing Address: 11-60 a nlinc Ko,,y( City: ori <br /> Contact Person: 0, ,Q, Applicant is: Contractor Homeowne (Circle One) <br /> Email and/or Fax: Ci��n�c:�14„���tdl Ate <br /> PROPERTY OWNE INFORMATIO <br /> Name: C -rLt 5 �b�A, 01, <br /> Phone(day): -1&'S 9_1;Ll ?y 51:. <br /> Address: wco -rot"n1,r`c Tzcr a City: ®r6A to ZIP: )qn1 SS 3 <br /> Email and/or Fax r ` >�n�•�,, u"7 �c wnr�CU" A,/4P \' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: M I-� C rtC1',r, <br /> Phone(day): 29-n• e32-Y- 1%q{ <br /> Address: 73ZQ011Zi City: 0,4, `4--/ ZIP:•SS,3 <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 /> ElNew Construction [Z Single Family with ❑Accessory Bldg./Garage Water Supply <br /> :Addition attached garage ®Deck <br /> El Accessory Building El Public Sewer <br /> EJ 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 <br /> MCWD Private Well <br /> Minnehaha Creek Watershed District <br /> ( ) El (specify) El (specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacEggK.org <br /> /7 <br /> Estimated Construction Valuation (excluding land) $ v 0OD <br /> Last Updated: January 2016 <br />