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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: <br /> ^jO Permit number: ; <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: — / —/-7 <br /> Street Address:' _._., _ ... <br /> Received by: <br /> �F L: 2750 Kelley Park�ay` �-7 Plan review fee: <br /> !�k@SHOOrono, MN 55356 <br /> Main: 952-249 �_.�,�(.. <br /> -4600 Total Fee: <br /> Fax: 952-2494616 www.ci.oron6.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: aq W llahl I w e S , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes will b� 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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 4,br- <br /> State License# 1q(oQ Expiration Date: 3//1- <br /> Phone: <br /> /1- <br /> Phone: cell So? Z Z- office) <br /> Mailing Address: (,)4-- City: ZIP: 3 <br /> 57 <br /> Contact Person: C r n Applicant is: ontra or / Homeowner (circle one) <br /> Email and/or Fax: S . C , CUI4 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax /wa{� , P, rg 6il�lrri CD�,I <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City- ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: Irl) ec�l <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> X New ConstructionWater Supply <br /> Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with El Public Sewer <br /> g y El <br /> ❑ Relocation detached garage ❑ Residence J'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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) , lQsj dUb <br /> Last Updated: January 2016 <br />