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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0 Mailing Address: Permit number: ;1 V1 7 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: — / /-7 <br /> Street Address:' Received by: <br /> 2750 Kelley Parkyvay, ! L'%� Plan review fee <br /> gkfSH� tc Orono, MN 55356\\... t U' <br /> �t <br /> Main: 952-2494600 Total Fee: �J p <br /> Fax: 952-249-4616 www.ci.oron .mn.us - ­/ 1 `2,3 <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: 67 W11116rw lJr`61/e S . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> H 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: Abr— <br /> State License# 1q(09 Expiration Date: 3//v <br /> Phone: cell 5- Z- office <br /> Mailing Address: A& City: ZIP: 3 <br /> Contact Person: e- l n /i Applicant is: (C-ontraefor / Homeowner (circle One) <br /> Email and/or Fax: 5 . C ►A . CUM <br /> PROPERTY OWNER INFORMATION- <br /> Name: <br /> NFORMATIO-Name: l4111'-C,4 atPo c <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Faxejarbx , P. 4G.4 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> M New Construction IM Single 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 12 Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ 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) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) Q6-/dam <br /> Last Updated: January 2016 <br />