|
� .
<br /> CITY OF ORONO
<br /> BUILDING PERMIT APPLICATION
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> �O A,O Mailing Address: Permit number:
<br /> �V PO Box 66
<br /> Crystal Bay, MN 55323-0066 Date received:
<br /> ,� StreetAddress:' Received by:
<br /> y�. G�'� 2750 Kelley Parkway Plan review fee:
<br /> `qxESH04� Orono, MN 55356
<br /> Main: 952-249-4600 Total Fee: o�J�Q 8
<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:
<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 approva/60 days prior to the event. Shutt/e 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: VG LOG� 7-��c on� aF,�c.,,c crf �4 i Q l—
<br /> State License# , Expiration Date: ,r,¢
<br /> Phone: cell ,��g 7 — �2.2 office
<br /> Mailing Address: �b t A��,�,c� �c✓v rz. City:,ac,cb,,,,,,.�c,..r-o,� ZIP: 55�6z
<br /> Contact Person: 7-�y�rY , ,� �.�--,-� Applicant is: �/ �
<br /> Email and/or Fax: To,�y , , ��,u,4rn � � h �e,� o�� �e.l � c �.+_,
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: G' ,T7 ,L v v�: 2
<br /> Phone (day): 2 -
<br /> Address: 23c� , � ,� City: p�y�� ZIP: 5.532 3
<br /> Email and/or Fax c<e �.,o� s � G.' . �,��r.�c� , •Y,,•i. c�S
<br /> ARCHITECT/ ENGINEER INFORMATION:
<br /> Name: l��? L.�-s�r�.,_,sirz' o�- �L�.���� , ���
<br /> Phone (day): (q5z� yu -�i.l,py
<br /> Address: p „� Cit : ZIP:
<br /> Email and/or Fax: G�,,,,,,,,�r� . L.�s-c o.-.�sK� , �Jr�llc n , co�
<br /> PROJECT INFORMATION: Description of project: —r' �}- ?�.p
<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 detached garage ❑ Residence ❑ Private Sewer
<br /> �Other: (specify) %��c v,7'� ❑ Multiple Family/Condo ❑ Retaining Wall(s)
<br /> �+,v�7t,�4- aEo�.4�Ene� ❑ 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 Blvd Q�T�tiF�s f�„���� �
<br /> Minnetonka,MN 55345 �
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.or
<br /> Estimated Construction Valuation (excluding land) $ ��o ,� �� �
<br /> Last Updated: January 2015
<br />
|