Laserfiche WebLink
' CITY OF ORONO � <br /> � �. <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O�T Mailing Address: Permit number: ��J ��gJ oL <br /> � 1 VO PO Box 66 � <br /> / Crystal Bay, MN 55323-0066 Date received: _� <br /> � ,'� Street Address:' G r.- ' <br /> y�, G`'� ��� 2750 Kelley Parkway `�0��''j���'-�'"J Plan review fee: - �`�" <br /> t�kESH04� Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us � t- t <br /> This application form must be completed in full and all required information mus'Nbe submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: j i S �i � �ti��t-`' ,�� c/�' <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. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-sife parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: ' <br /> Name: �� «�''�� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: Cit : <br /> Contact Person: Applicant is - Contractor / 'Homeowner (Circle One) <br /> — �--- _ <br /> Email and/or Fax: ---����n,��f�, :?�L:;��� <br /> PROPERTY OWNER INFORMATION: <br /> > > <br /> Name: (1�l.S ��'�"1 �;�Sto�, ������r� <br /> Phone (day): �/� -�7 .S�-� , 7/ , � _ <br /> Address: / t.✓ r - Cit : - �S i��� ZIP: -' <br /> Email and/or Fax '"'� - � < � ; " rn, � n : � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> � �,Q(,�� � C�-r'�C��i� � �C��� � �Udf <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 ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Off�ommercial <br /> � <br /> ❑ Relocation � I detached garage Residence ❑ Private Sewer <br /> Other. (specify) �c'r�7:��c'E' ❑ 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 Lc����, l�i , S l�2iClSc�V/�j�p�� <br /> Minnetonka, MN 55345 � <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> $ /��`-� <br /> Estimated Construction Valuation (excluding land) ����� <br /> Last Updated: January 2015 <br />