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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �C) Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> � Street Address:' <br /> Received by: <br /> y� Gtr' 2750 Kelley Parkway Plan review fee: <br /> `gk6SHO4� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee; -7,-7 ID <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 su bmltted. <br /> Incomplete Ap i icatlons uvIll be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2G31 WAY 2-4TA BLV6 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes 19 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: 601kb N :TAsne S CONST. <br /> State License# SC _V31914 1 Expiration Date: 3-31- (1 <br /> Phone: (cell) 6/2- 3&T- 373& (office) 743- y7q- 311'7 <br /> Mailing Address: PIQ 30k 30& City: ZIP: <br /> Contact Person: -0E Mc P14 E ASCAJ Applicant is: o rac or / Homeowner (Circle one) <br /> Email and/or Fax: a t 0p, ss, Com, <br /> PROPERTY OWNER INFORMATION: <br /> Name: 01towo 'PtAeLle. SGNoocf <br /> Phone(day): 743 - - 075" <br /> Address: tolS' N. veb cAyj?*t UY Rt> City: Lava 1AX ZIP: .1'T3S*4 <br /> Email and/or Fax i*%ecomi 60-040 . X12 . r4rl. (A.$ <br /> %J fil <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: WOG a AActfd?'ECTS <br /> Phone(day): GS 1-Z 217-11?013 <br /> Address: 332 01SNNES4TA .S?' - $Uzi* W41000 City: .ST• R9NC ZIP: .SS'/O / <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of project: etoff ?^� �vF G4p DOOR <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ElNew Construction ElSingle Family with ElAccessory 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) Cul' O.M. �eoR El Multiple Family/Condo ❑Retaining Wall(s) <br /> C^^/ ElPublic 4-feet or greater ❑Public Water <br /> "Any earth movement may also require ®Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial IgWarehouse ❑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.minnehahacreek.or <br /> $ <br /> q 00 <br /> Estimated Construction Valuation (excluding land) ocu ®f.� <br /> 1S <br /> Last updated: January 2016 CITY OF ORONO <br />