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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> 0� Mailing Address: Permit number: 4&1,57.- D0`11 <br /> et O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /- 3/-/c' <br /> Received by: /8-",eeL`a <br /> t �,, L Street Address:' ..,49/\ 40-,V . <br /> ''s'<, 2750 Kelley Parkway Plan review fee: <br /> 77.�kEfc, Orono, MN 55356 Q <br /> Main: 952-249-4600 Total Fee: ;, 3 n <br /> Fax: 952-249-4616 <br /> 249-4-4616 www.ci.orono.mn.us `� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplet ap lications will be returned. (Pease print) <br /> GENERAL INFORMATION: l�u Z-Gc �CfI <br /> Job Site Address: `-y4 _ F <br /> P-7 . �. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <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 dill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I ORMATION: <br /> Name: ,R t4L (,'/1.:4) i L-L <br /> State License# St. 7/YS-is-- Expiration Date: -471;,--2.0. c> 3- 31.Vic: <br /> Phone: (cell) 6 S/. 2-3 ' , 5-3177 (office) <br /> Mailing Address: 2 3/5- SF'/Zi/2 /43Z- Cit : �� ZIP: 537/U <br /> Contact Person: L h,;, - Applicant is: ontractor )- -Homeowner (Circle One) <br /> Email and/or Fax: rim b ,6,i'! (gj S _ ��tf s,,‘._6i ./ Lc ti <br /> ii <br /> PROPERTY OWNER INFORMATION: �- <br /> Name: 1,(),�Y2A-T4 C C <br /> Phon€ (day): GILA <br /> Address: 2c' LOA Y2.�4f7- �0/�10 Lm - (9/� City:W,41- .€#,ci1P: 55-31/ <br /> Email and/or Fax , . <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I' - -- 614‘- &-- 7 4 /‘T/4 <br /> Phone (day): {,/Z , -7&7 75-F f <br /> Address: ye V72.. icitg,ige sib/ - S City:X4za,_6‘,,P0z,/1 ZIP: S`-may/© <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New ConstructionWater Supply <br /> 0 Single Family with Accessory Bldg./Garage <br /> 0 Addition attached garage Deck 0 Public Sewer <br /> ®'Accessory Building 0 Single Family with 0 Office/Commercial <br /> ❑ Relocation �i-cyi--� detached garage 0 Residence Private Sewer <br /> 0 Other: (specify) 5444'l( 914'-1< 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> gCliAeL-Ai 1 744-44/1-4 ❑ Public 4-feet or greater ❑ Public Water <br /> `*Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse ,Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> RECEIVED <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 3 // yC10 JAN 3 r iti <br /> CITY OF ORONO <br /> Last Updated: January 2015 <br />