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CITY OF ORONO <a . <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: <br /> l V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �q /7 <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: :6 "-2 o <br /> &AF <br /> lAkESH� Orono, MN 55356 a.o013 9 <br /> Main: 952-249-4600 16 Total Fee: <br /> Fax: 952-249-4616 V"www.ci.orono.mn.us C��0-#7 <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, emodelers Showcase Home or other Display 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 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 TI N: <br /> Name: xeeo a oo ffG <br /> State License# *x-5'J..; Expiration Date: <br /> Phone: cell office '2 - 2Z <br /> Mailing Address: Cit ZIP: <br /> Contact Person: Applicant is: ontrac" M / Homeowner (Circle One) <br /> Email and/or Fax: N0 <br /> PROPERTY OWNER INFORMATI0 <br /> Name: <br /> Phone (day): — V <br /> Address: City: akyft ZIP: <br /> Email and/or Fax /Yle ce <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SAW <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description ofproject: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ 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 ❑ 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) ❑Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www rninnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ <br /> Last Updated: January 2016 <br />