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• CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA,. Mailing Address: Permit number: ��,�I�� ' ��� �'� c <br /> � �VO PO Box 66 �j- <br /> Crystal Bay, MN 55323-006� Date received: � Z <br /> � �� � � ,� � Received by: �/� <br /> Street Address:' ��y��� � <br /> y�, G` 2750 Kelley Parkwa� �1���l (,n •r Plan review f : <br /> �i � . <br /> �qk F S H��h. Orono, MN 55356 L � L �� <br /> Main: 9 5 2-2 4 9-4 6 0 0 ��1� �� Total Fee: 3 �5 <br /> Fax: 952-249 4616 ��vw�v.c,i.orono.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: -ZS '(3(2��.,••.1 (t,p s, <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 I APPLICANT INFORMATION: <br /> Name: �3Fr(Z�' �Of'F cot`lsT. �N c, _ <br /> State License # 'C� C o�F�f 59 7 Expiration Date: 3• 3( • l'7 <br /> Phone: (cell) ��Z• �6"f- S�5 (office) <br /> Mailing Address: g� �•{ ��yo���aao O2 - City: C-��.-� �1Z��IP: � 53 4"1 <br /> Contact Person: '[;p Q Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: Lpp.� Z. � ,�„�o. ��y.�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: J'1w��,,`_ o� ��.�.� N 4..�or► <br /> Phone (day): <br /> Address: *ZS Qr�•••�+ R� � . City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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 /> [�'bther: (specify) Q�� Rprl�ioC�_ ❑ 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) $ Z( � O 0.� � <br /> Last Updated: January 2015 <br />