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�g <br /> CITY OF ORONO 2� <br /> BUILDING PERMIT APPLICATION �,� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �Q j _ f 4 Mailing Address: Permit number: ��`c�'�� <br /> 1VO t' 1' CrysBtal Bay, MN 55323-0066 Date received: ' � " � <br /> �n �p`;' Received by: <br /> � Street Address:� <br /> �`{ � <br /> y � _1 2750 Kelley Parkway Plan review fee: <br /> ��"�kESNO��� Orono, MN 55356 ` <br /> Main: 952-249-4600 Total Fee: � <br /> Fax: 952-249-4616 www.ci.orono.mn.us u <br /> This application form must be completed in full and all required information must be submitted. �/�(�lVtO�"� <br /> incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION;�.� .f � � <� �� ��� � '`� � �,�-,-, �. ,� ` ��,� ;��-�,� 4 <br /> �:. � �� <br /> Job Site Address: �' ` f� ' <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. Shuttle bus service wiU be <br /> required unless applicant demonstrates sufficrent on-site parking is available. IVon-permitted events witl not be aJlowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: �:��'i ����,��C�' <br /> State License# � Expiration Date: <br /> Phone: (cell) 2� t� c ���`�1 �� 7 7' � (office) <br /> ,� ..r '' � �°`v�-�-� City: �:���*_4-� ZIP. ..� �">�k f <br /> Mailing Address: �2��-== ���-�� �'T �`�� - <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One} <br /> Email and/or Fax: `..�,• �/` ' ``'� �'".�^��� . �°�-* <br /> PROPERTY OWNER INFORMATION: ,�7 ,i <br /> Name: '`� ---- :.._ � ' i'�'�- <br /> Phone(day}: � � `�' ` <br /> Address: City: ZIP: _ <br /> Email and/or Fax <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:��� `������ ��'�'�1 <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 /> ddition attached garage �Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wail(s) <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) ❑Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Bivd ��� <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 /> � <br /> Last Updated: January 2015 <br />