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� <br /> CITY OF ORONO 5� <br /> � /�{,�7� <br /> BUILDING PERMIT APPLICATION l `� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number. �L ��-- C� ��� � <br /> O PO Box 66 <br /> Crystai Bay, MN 55323-006�r/�.� Date received: � L ��i�`�S <br /> Street Address:� Received by: '> � c���� <br /> � � _ .._ <br /> � _ _- <br /> y�. G�'� 2750 Kelley Parkway �� Plan review fee: (' C�� � ,� �4 ��_ <br /> l�kFsxa�`�` Orono, MN 55356 �p `_-__ ��_.� ,� ,Uc �• a % <br /> Main: 952-249-4600 Totaf�es: _------------- � <br /> Fax: 952-249-4616 www.ci.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: _ 1(��"1 � � � , <br /> Y �, <br /> .�__: ,r , r_��: ;. -. <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 Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP I A T INFORMATION: <br /> Name: � t)Y'J �;;;��. ` � i";' .. <br /> State License# '� Expiration qate: <br /> Phone: cell � s '��`- �' �� office ��'� �"x//-� � � <br /> Mailing Address: �� � a � �-, Cit : `�' ,: ��, ; • , '•`ZIP: s���';'� <br /> Contact Person: p ,�} �yv Applicant is: ��hIf��a���ctor )/ Homeowner (Circle One) <br /> Email and/or Fax: _ ��j�� � �/�ftic c.,� O � ��m('� �' �,/t�E� <br /> , <br /> PROPERTY OWNER INFORM�4TION: <br /> Name: --L_j-�Q.^., �,N� ��'j��Fa- l�'Z <br /> Phone (day): <br /> Address: �� �o �J s' F ,� � ��� City: ' r'7 �',�y ; , ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFOR ATION: <br /> Name: �'�'� ���r! l <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 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building �.��E���� ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation / ' detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other.(specify) ���UC'�rJR� ( ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �h�r✓�;,� � . <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) ❑ pther:(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) $ ��� ��(� � <br /> __ „ <br /> Last Updated: January 2015 <br />