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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION ` <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O No Mailing Address: Permit number: / -bl 1 PO Box 66 v Date received: <br /> Crystal Bay, MN 55323-0 <br /> Street Address:' <br /> Received by: <br /> y 2750 Kelley Parkway c '� Plan review fee: <br /> F <br /> l� ��C Orono, MN 55356 a � ��CJ Otl7: <br /> kfSFIO /� 000.00 <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: 1 , <br /> Job Site Address: -5-41 3 Wrj'f<V( '1©l.11n <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 0 Yes P 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 INFORM TION: <br /> Name: w <br /> State License# Expiration Date: 3 3I_ ) <br /> Phone: cel - ')L2 office <br /> Mailing Address: /;10.S O City: ZIP: I <br /> 777 <br /> Contact Person: Applicant is: ontra6tor / Homeowner ircle One) <br /> Email and/or Fax: i <br /> PROPERTY OWNER NFORMATIO : <br /> Name: / v <br /> Phone(day): Gla —?6y <br /> Address: City: ©U ZIP: <br /> Email and/or Fax <br /> 1 <br /> ARCHITECT/ENGI ER INFORMATION: <br /> Name: CtZ <br /> Phone(day). - L <br /> Address: �� `� 15+ Sd-r-e,nfi 5cri A _ City:5�70 � , t ZIP: 32C� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> j(New Construction Single Family with ❑Accessory Bldg_/Garage <br /> ❑Addition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑Relocation detached garage Residence gPrivate 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 KPrivate 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.iTiinnehaha(ieek.org <br /> Estimated Construction Valuation (excluding land) SNOV 0 <br /> CITY OF ORONO <br /> Last Updated: January 2016 <br /> Last Updated: January 2016 <br />