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` CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: <br /> l VO PO Box 66 <br /> Crystal Bay, MN 55323-0016Y4� <br /> 5323-00 4� Date received: <br /> Street Address:' �� Received by: <br /> ti� Gti 2750 Kelley Parkway Plan review fe <br /> `gkESHO�� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: 8 3,7v <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: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Displ y 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 serAig will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: MIn-. -( - o <br /> State License# lf'�C 4{o o')7 1 Expiration Date: 7_.j I- <br /> Phone: cell) q-yiI (office 5l- 2-2,4 - ?oo p <br /> Mailing Address: 1:54a r 6(,vt Cit : -E t Pik ZIP: $q/-G <br /> Contact Person: 7,',,., Frd' Applicant is: ontractor / Homeowner <br /> (Circle One) <br /> Email and/or Fax: -A �o r S A ra �/� al��f �•3 r�-�. �,.� <br /> 1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: aG� s JI- (^�rA— C"r IS,\ <br /> Phone (day): <br /> Address: i5S Trw fF�la 6�. 1 City: 01',5 ^6 ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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. Structhre Type 4. Sewage Disposal& <br /> El <br /> Construction Single Family with [:1 Accessory Bldg./Garage Water Supply <br /> ❑Addition attached garage ❑ Deck <br /> [:]Accessory Building El Public Sewer <br /> El Family with El <br /> ❑ Relocation �I detached garage Residence EJ Private Sewer <br /> Other: (specify) /ce-*, Multiple Family/Condo Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "Any earth movement may all o require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> Private Well <br /> Minnehaha Creek Watershed District(MCWD) ElOther: (specify) ❑ <br /> 15320 Minnetonka Blvd ( p ) ❑ Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) Q&d <br /> Last Updated: January 2015 <br />