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, ! CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �i /�� Mailing Address: <br /> �"�` rO PO Box 66 Permit number: 28 �S-- �� �p <br /> Crystal Bay, MN 55323-0066 Date received: /Z — �� - %� <br /> �eceived by: �Z'� <br /> ,� StreetAddress:' S � S <br /> ��. G.'� 2750 Kelley Parkw 2�� _�� CJ� �Ian review fee: S <br /> ��xESH�4� Orono,MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ? rpwn a <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicanf demonstrates sutficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> tvame: � warz t.ti�dt�s 2►tc . <br /> State License# 6 C o0 3q aa Expiration Date: 3 3 ao !o <br /> Phone: cell l - 38l0- 8Y� office � - 7 - 7 8 <br /> Mailing Address: 5/t ton� O Cit : 'n tf ZIP: 553Y5 <br /> Contact Person: Applicant is: ntractor / Homeowner (Circle One) <br /> Email and/or Fax: r 5 wq,rL rs, e�►1 <br /> PROPERTY OWNER INFORMATION: <br /> tvame: _ Rob i •l l��i C��I� l�tif/�"�r <br /> Phone (day): � <br /> Address: S Q Cit : jqd erden.�,c z�P: ,5.5359 <br /> Email and/or Fax b. ��� - �-. �o <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �l}L Ra���T�crs LLC. <br /> Phone (day): g5 a- �O! - (0 0?!0 <br /> Address: (5/l 9 /Y1 i�nG�Onl�4 �ud_ ,SuitC lOd City: /Y�j�n�?fpnl�c� ZIP• 553�/S <br /> Email and/or Fax: r �wt (o� �rnA�( .��rh <br /> '� U <br /> PROJECT INFORMATION: Description of pro'ect: c�r``f%�'+ � ���� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal8� <br /> ❑ New Construction �Single Family with Accessory Bldg./Garage Water Supply <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) �n'�Ltior�tAo�a�'�nn ❑ 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 8 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.mi nnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 30�� 0(�Q�, F1(7 <br /> Last Updated: January 2015 <br />