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f CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��O A , Mailing Address: Permit number: c is 0 � '0 13 � <br /> � <br /> PO Box 66 / <br /> Crystal Bay, MN 55323-0066 Date received: O f2�5 I 1 1e <br /> A S. Street Address:' Received by: D <br /> 1‘.e\ 1, c'\:'" 2750 Kelley Parkway 0 1 it -7 _ Plan r view fee: 8/. 89 <br /> tlkEsHo��` Orono, MN 55356 13 (r, _� <br /> Main: 952-249-4600 To al 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: \\2S ;, vt\e„. ntvr_.____ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes I I 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 INFORMATION: <br /> Name: Ou:-69ca- c ..e9 r <br /> State License# —C S3 c('5'.3 Expiration Date: 3/../7`$' <br /> Phone: (cell) -7(0S-2- - 2.-('Z9 (office) ei2-9 (62(1? )(l•( <br /> Mailing Address: '2-3't _ �<.te.ts ►c_._- Cit : L,,,„ Lr., ZIP: .Sc3 <br /> Contact Person: eS Applicant is: ontrac j/ Homeowner (Circle One) <br /> Email and/or Fax: k fvec e-o�., .64r c5:c,„rte <br /> PROPERTY OWNER INFORMATIO : <br /> Nome: ✓,Kcr A - ;\(.7,:n.-\.t' <br /> Phone (day): is 2-22/ rZ <br /> Address: I\2S - vi' N)N=v City: C)(-0(. . ZIP: S3.j-L) <br /> Email and/or Fax pty ,�;c-( e.cp,,\.�e„- <br /> ARCHITECT/ ENGIN ER INFORMATION: <br /> Name: , _ Lc:NZ <br /> Phone (day): `is2--e 2c12_,--9-7 1 '2 <br /> Address: 'Z3yc .br.4 _& S' eke City: (,.cr LCL ZIP: sc - <br /> Email and/or Fax: 0,(%.,}z..fin„,- „(2x.e r c„;...._ <br /> 19 PROJECT INFORMATION: Description of project: co o s �Q -0 <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ccesSOry BI /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 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) "O her: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd ` \' AS <br /> Minnetonka,MN 55345 /�.— <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ Z'4 <br /> Last Updated: January 2016 <br />