Laserfiche WebLink
. <br /> ' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �C � �`°'dG �� � <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �.J`�� � <br /> eee�ed-�y---------��2__ 210 <br /> StreetAddress:' O � � <br /> y� G� 2750 Keiley Parkway �p��J`C�� Plan review fee: ' <br /> Orono, MN 55356 <br /> ��kEswo�`�' <br /> Total Fee: <br /> Main: 952-249-4600 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 appiications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �[o"? `� ���� ��,� 7" !2«vrt� <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 repuired with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wilf be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: AV�p � )i�,7E Z� INC <br /> State License# G '7 Z. Expiration Date: 3-�I -z n 1�-�- <br /> Phone: (cell) 0{2 - '�5 O � �-1-�1 O (office) (�l Z- 7 5�7��t1�1 C"� <br /> MailingAddress: 2 �Sv � s u� �%� . Cit � �..tG�,���,�� ZIP: �50 <br /> Contact Person: TE,�zs,.f FV�„e5 Ur-• Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: -fi-��� u,�,d b.,, 1 d e..r-5��+� . C'c'�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: t��-.w t �•��-.r c�r.�c��x— <br /> Phone (day): S�-7 � �:-t c� � (r,4 q� <br /> Address: ��,� 7 C /-}SCt� t�U�i- � City: �„1��'7a►T)� ZIP: S��� � <br /> Email and/or Fax �,_�-�S i^�,{ r �� L (r� c� ►�►-►-� �"G,c,.e <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 /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with [�Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation ��J�= �� � detached garage ❑OfficelCommercial ❑ Private Sewer <br /> �Other. (specify) I�Fh.SE p��� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (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� �a �`'• ��`� <br />