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� , � CITY OF ORONO <br /> �UILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: ���'��5� <br /> f wO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> a Street Address:' G ic� ' <br /> ��. G� 2750 Kelley Parkway`�o� -r'j--�5 Plan review fee: _ ��{ <br /> ��kFsxo�`�` 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 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: �S� �o�s�`� ,� �/� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Horne? Yes ❑ No <br /> lf 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-site parking is availab/e. Non permitted events will not be a//owed. <br /> CONTRACTOR/APPLICANT INFORMATION: ` <br /> Name: J �^--�� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: Cit : <br /> Contact Person: Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: �' t �W �- <br /> PROPERTY OWNER INFORMATION: <br /> Name: o So�'1 C'r��fo•2, ��9�PG <br /> Phone(daY)� /� -�7 S=�'�7% / <br /> Address � � t,✓ ,r Cit : `� .��s�o� ZIP: <br /> Email and/or Fax p - C tp <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> �.QC�2- �G�-��` �{ �/,�� �` �DD�- <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 ����� ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office ommercial <br /> ❑ Relocation r detached garage Residence ❑ Private Sewer <br /> Other. (specify) �eh'1 d ❑ 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 <br /> Minnehaha Creek Watershed District MCWD ❑ Private Wel) <br /> ( ) ❑ Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd L���(,•,,� , �y(ZopSq(���p9r'' <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> $ /O� <br /> Estimated Construction Valuation (excluding land) �� <br /> Last Updated: January 2015 <br />