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1 <br /> , r <br /> CITY OF ORONO .- <br /> BUILDING PERMIT APPLICATION .S,��Lpo%� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: �l.s' � � <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0 66 Date received: �� ( � <br /> � �, Street Address:� �� Received by: <br /> �. `� 2750 Kelley ParkwayC �/�, Plan review fee: ��• o <br /> `qKESH��� 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: %y/o G��r�, �/��� <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 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: �{o�e.t.�+oD.� LLG <br /> State License# ,aG�9�/ 3 i S Expiration Date: 3 3� Zol(, <br /> Phone: _(cell) !�l Z • �f01 • 33�-($ (office) (a/Z • y(o2 • �/Giap <br /> Mailing Address: /S3 E. ��� ��� Cit : a 2a a ZIP: S"S3q/ <br /> Contact Person: a s ow ,-//,' s Applicant is: ntrac / Homeowner (Circle One) <br /> Email and/or Fax: ,'a,so.,. s�o�� • cow <br /> PROPERTY OWNER INFORMATION: <br /> Name: cv�'K o,w� %u-oSA � v c-�so.� <br /> Phone(day): 97Z lak3 • �aS3 <br /> Address: lNlD vvy /� ..�s City: �rono ZIP: �`S3lvy <br /> Email and/or Fax ��v;,� -�ov�kwsoµ(�i �+�w:( . Cow� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 7k�.e, f�a�s�n. G�-awp <br /> Phone(day): U,/Z • 7pSa • 3S 72 <br /> Address: 3�-107 �C;�w�u. L�•..�.� �o��► City: �y w.ou.�.. ZIP: �`'1 N <br /> Emailand/orFax: ni� � �.o,..�.sc.ti�..owp�.�,,,�. cpw� <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation ,1 detached garage ❑ Residence ❑ Private Sewer <br /> �Other: (specify) po..-t'�ow$t ❑ 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 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �.Other:1(Specify) �][ Other�(Specify) <br /> 15320 Minnetonka Blvd ��-M•ouS2 aaw-1'koµ�e j��A' <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ZS�Do� <br /> Last Updated: January 2015 <br />