Laserfiche WebLink
��-�3 <br /> _ � <br /> � ' CITY OF ORONO � �� <br /> r BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITION � <br /> �O� Mailing Address: Permit number: v�C � �"" QG _3 � <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��T� /U� � <br /> __._ -Received by: --�-�.-- <br /> Street Address:' -�� -�0 Z�C���( <br /> � �- . <br /> y � 2750 Kelley Parkway ��pl�j'Ov Plan review fee: ' � ,� <br /> `�tq �,� Orono, MN 55356 __-- --- --__ ___._ <br /> kESHO� _ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �(,�'� 5, (L},� <br /> This application form must be completed in full and all required information must be submitted. 1�0�( tJ(,�'j�/ <br /> Incomplete appiications will be returned. (P/ease print) ��T <br /> GENERAL INFORMATION: �_ �K���t ��UQ <br /> Job Site Address: ''��`� �� �ir S<�% �%��� T� l�u�i� 5'�"� <br /> Will this be a Parade of Homes, Remodelers Showcase ome 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/APPLICANT INFORMATION: <br /> Name: �V1� �1:� )���7E iZS INC <br /> State License# L -7 L Expiration Date: 3-�� I -����-�- <br /> Phone: (cell) I Z - '"7�� - �-1�`1 C> (office) �l 2�- �`.'j O -cl C 1 C� <br /> MailingAddress: Z t�S� ► s ue �� . Cit � �...�C:��,��L�F ZIP: �`��p - <br /> Contact Person: 'T"E_�� �'UC„e`,Ur.,., Applicant is: ntrac / Homeowner (CircleOne) <br /> Email and/or Fax: •1--�r r„� � t��,d b✓, t d e_r'S m+� � C'��- <br /> �� <br /> PROPERTY OWNER INFORMATION: <br /> Name: P�.u: t ����r ��-.,tid P sz-- �I.-r'SnyC�Ca''�U.hO�'MQ.�M.C�l� <br /> Phone (day): �p� _ �..�...t� .- �q q z� <br /> Address: C r-� � � Cit : �- ZIP: S� 3C� 1 <br /> Email and/or Fax �,,�>�'S Y��,.{ d e r C' In � ✓'r�� (c�,c,� <br /> ARCHITECT/ENGINEER INFORMATION: ZgbS � PN� SW J I��"tY1 MN���,�.__ <br /> Name: / <br /> Phone (day): ti, <br /> Address: —T�� City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction D[�Single Family with [�fZesidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building � ❑ Single Family with ❑ Deck <br /> ❑ Relocation ('�v�= �� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other. (specify) (R1.SE �i-f�u� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 5, c�p c'. c�,! <br />