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. " CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A TO MailiPO Boxr <br /> �O ess:66 CV-�(Q� Yate <br /> number: I - 7 S 2 <br /> l V Crystal Bay, MN 55323-0066 CJ 1 'Date received: 2 1 <br /> Street Address:'y� G Received by- <br /> an _0 <br /> 2750 Kelley Park ay Plan review fee: <br /> kESHOR� Orono, MN 55356 <br /> Main: 952-2494600 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: ,,v1 <br /> Job Site Address: 7 �d 0t-a,,�o l5 535 ic <br /> Will this be a Parade of Homes, Remode s Showcase Home or other Display Home? El 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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATION: <br /> Name: maet <br /> State License# Expiration Date: <br /> Phone: cell / office <br /> Mailing Address: _001 p City: .", 11,0 ZIP: I <br /> Contact Person: Applicant is: Contractor J Homeowner (Circle One) <br /> Email and/or Fax: eGot-1 <br /> PROPERTY OWNER INF RMATION: <br /> Name: e -Self 6i-o✓ <br /> Phone(day): - 13 _[ 1 , - t di 5 <br /> Address: 5 L, , o Cit :6� -e4 1AI-e ZIP: L60L15 <br /> Email and/or Fax vrie p <br /> ARCHITECT/ENGINEER INFORM TION: Q <br /> Name: g" I-, V L tc <br /> Phone(day): 51- qQ 7-6,0 Sk Y' <br /> Address: 3 5 2 L04t 62"AJ�jCit : +t 4tV 4P: � <br /> Email and/or Fax: <br /> rrlao 0f- 0o✓ rtAtl �,t <br /> PROJECT INFORMATION: Descri tion of pro'ect: �11;lal 1z, <br /> exi <br /> 1. Type of Project 2. Proposed Use 3.St cture Type 4. Sewage Disposal& <br /> Water Supply <br /> ElNew Construction ElSingle Family with [IAccessory Bldg./Garage <br /> ErAddition attached garage ❑ Deck Di/public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> �f Other:(specify) Va-1 ❑ Multiple Family/Condo ❑ Retaining Walls) <br /> ublic 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) 'O-Other(specify) <br /> 15320 Minnetonka Blvd 2 <br /> Minnetonka,MN 55345 <br /> Phone: 952471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> /� • <br /> Estimated Construction Valuation(excluding land) $ � I Q0p <br /> Last Updated: January 2015 <br />