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CITY OF ORONO
<br /> BUILDING PERMIT APPLICATION ' S' 0 ,?9 92L
<br /> FOR NEW STRUCTURES OR ADDITIONS Q
<br /> �Ol V Mailing Address: Permit number: 40/7-1/0!3 1
<br /> O PO Box 66
<br /> Crystal Bay, MN 55323-0066 Date received: 9—//-I 7
<br /> Street Address:' Received by: p�9e. ` 2750 Kelley Parkway Plan review fee: 1-9, �03•,lY
<br /> 9&ESHO��` Orono, MN 55356 a0/7_ o,v 91
<br /> Main: 952-249-4600 Total Fee: e
<br /> Fax: 952-249-4616 www.ci.orono.mn.us AO /7-v /D / &.,
<br /> ,
<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: ni
<br /> Job Site Address: I Le`f W.,1Atikr4 lfett
<br /> Will this be a Parade of Homes, Remodelers 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/APlrICANT INFORMATION:
<br /> Name: vittktAA.o. ��
<br /> rIC aAt-'i 1 AC.
<br /> State License# F,C 39.3Jr54- Expiration Date: /4i/I7
<br /> Phone: (cell) g5'2-2"►2. -041-3 (office)
<br /> Mailing Address: 72.0 5„,„xt (`,r.4.4_4‘ lav_,„ , City: S•&v,:4-etc ZIP: SS-1'7e
<br /> Contact Person: „., 4 Applicant is: Crit acto / Homeowner (circle One)
<br /> Email and/or Fax: J,,AA, M Lu+ tv,c.,‘„,,,,,{,cce, 'Lt1-'-
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: -row, it iG,k‘,1 kkt4-
<br /> Phone (day):
<br /> Address: 1704 Q.lal‘t;xd,- 44ra,L. City: CA,;;,„A D ZIP: 5S414
<br /> Email and/or Fax
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Name: e r lvt-ka.•
<br /> Phone(day): 9c2.- 210 .. f,O 2 /►
<br /> Address: 2..' � rt." 1.),..r.1/4e,... City: Ctu....(c,g ZIP: 5V5i7
<br /> Email and/or Fax: },r.+�\,. iMc- � , rc,� �-
<br /> PROJECT INFORMATION: Description of project: Ott,...) c,.-i
<br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
<br /> Water Supply
<br /> [$J New Construction Single Family with ❑Accessory Bldg./Garage
<br /> ❑Addition attached garage ❑ Deck ErPublic Sewer
<br /> ❑Accessory Building 0 Single Family with ❑ ffice/Commercial
<br /> ❑ Relocation detached garage 0 Residence ❑ Private Sewer
<br /> ❑Other: (specify) 0 Multiple Family/Condo ❑ Retaining Wall(s)
<br /> ❑ Public 4-feet or greater 0 Public Water
<br /> **Any earth movement may also require 0 Commercial 0 Storage
<br /> MCWD review&permits. 0 Industrial ❑Warehouse [Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 0 Other(specify)
<br /> 15320 Minnetonka Blvd
<br /> Minnetonka,MN 55345
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.orq
<br /> Estimated Construction Valuation (excluding land) $ eaaz RECEIVED
<br /> SEP 1 1 2017
<br /> Last Updated: January 2016
<br /> CITY OF ORONO
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