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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��l V Mailing Address: Permit number: o�D l 8-VV 3/ <br /> O PO Box 66 zz <br /> Crystal Bay, MN 55323-0066 Date received: cJ— 5-1 g <br /> Street Address: <br /> Received by: <br /> yF L� 2750 Kelley Parkway Plan review fee: V 1,°Z <br /> ktstioOrono, MN 55356 !R_ 3/ <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: Z-76 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes J;44% <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: 'k,,b L V6c-sr-(y, _ \-)L- <br /> State <br /> L _k���,�✓csf7.�-.! <br /> State License# 3 C S 7 b(2 Z Expiration Dat—�-31^/g <br /> Phone: (cell) (office) <br /> Mailing Address: re,►t,,1 1p�p. Cit ZIP: <br /> Contact Person: Applicant is: ontracto / Homeowner (circle One) <br /> Email and/or Fax: C <br /> PROPERTY OWNER INFORMATION: (.Q' —�`) <br /> Name: 5 za- C, , Q <br /> Phone(day): &1.7 _ ZI <br /> Address: Z7i} �j t.� 5 "alk City: p(L,p.z, ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: X A�A <br /> Phone(day): DZ 7 9 <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ElNew Construction ElSingle Family with ElAccessory Bldg./Garage <br /> Addition attached garage ❑ Deck ❑ 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 <br /> ❑ 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 /> MAR 2 12018 <br /> i <br /> Last Updated: January 2016 CITY OF ORONO <br />