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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION 76. ';�'g <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: Permit number: <br /> PO Box 66 C� <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' � Received by: <br /> ti G� 2750 Kelley ParkwaZ�I:rol <br /> �l Plan review fee: /71, <br /> F <br /> `gK£SHD�� Orono, MN 55356 a 0!8-Oa�2 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 no.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: <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers S wcase Home or other Display Home? es ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/ b s service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO <br /> Name: — <br /> State License# MLI l9425 Expiration Date: <br /> Phone: cell Z - office Z -- — 79 3 <br /> Mailing Address: nth 42 , 'City: ZIP: `-M <br /> Contact Person: Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: k <br /> PROPERTY OWNS INFORMATION: J� <br /> Name: ! A l-tam t L4-z,-, <br /> Phone (day): <br /> Address: City: `�•l.< ilS 'IC. ZIP: l <br /> Email and/or Fax r , <br /> ARCHITECT/ENGINE13R INFORMATION: <br /> Name: X &V 8 94E5 <br /> Phone(day): -- � Z"1 — //,^ _ (f <br /> Address: City: 46 f'r <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 /> 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) I���M Multiple Family/Condo El 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) R Other(specify) <br /> 15320 Minnetonka Blvd 0lVj7,111\26- �WMA <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590r Dr A <br /> Fax: 952-471-0682 "�t <br /> www.minnehahacreek.gM <br /> Estimated Construction Valuation (excluding land) p <br /> MAR 0 7 2018 <br /> Last Updated: January 2016 CITY OF ORONO <br />