Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS Q <br /> Mailing Address: Permit number: 5;,74� 0 g <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a Street Address:' Received by: <br /> y. G: 2750 Kelley Parkway Plan review fee: <br /> lgkES110�� Orono, MN 55356 <br /> Main: 952-249-4600 ToFee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us 136 ?,K) <br /> This application form must be completed in full and all required information must be submitte . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I-CALA1 <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/APPLICANT INFORMATION: <br /> Name: \N 5-r<tt�. C�►-�s,R.Ymo�.� <br /> State License# jot(tq-$ Expiration Date: <br /> Phone: (cell) 9GiZ- Zt A -`tIUZ Mice303 - LI23U <br /> Mailing Address: ►aQxx-> ykxy ,,,�,s _S .�E City: ,P,jfi._ ZIP: 3LJS <br /> Contact Person: Applicant is: ont ac or Homeowner (Circle One) <br /> Email and/or Fax: a\e-Oyca Q ck nivoc6,C -_ <br /> PROPERTY OWNER INFORMATION: <br /> Name: 1vhr. Mie`n�\� Aot't <br /> Phone (day): X103- - <br /> Address: yi141 Cksrp �c�>J� 'i.p _ _ City:Qcor.,_> ZIP: <br /> Email and/or Fax M".ryw_�P_, c _QV_1 rV <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A . Qe ;� <br /> Phone (day): `yt ?_- 303- L4,L30 - <br /> Address: t�&�c� N� Y��e�s� '�c.ve City: ZIP: J5C-,,%5q_6 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of roject: _ <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> ❑ New ConstructionWater Supply <br /> ❑ Single Family with %Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> El Accessory Building El Public Sewer <br /> El Family with ❑ Office/Cornmercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Private Sewer <br /> [� Other: (specify) cif_"�-��-� b F ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> 55 ❑ Public 4-feet or greater El Public Water <br /> **Any earth movement may also require El 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) $ Uc�C� UO RECEIVED <br /> APC h) ?d1b <br /> Last Updated: January 2016 CIN OF ORONO <br />