Laserfiche WebLink
CITY OF ORONO Z� <br /> BUILDING PERMIT APPLICATION ( D S,- <br /> FOR NEW STRUCTURES OR ADDITIONS �`�-�" <br /> �O�O Mailing Address: Permit number: C�O��j�— ��J <br /> 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 /> `� Orono, MN 55356 <br /> `qkFSHo'�`` ��7 l/ <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 applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> �. <br /> Job Site Address: / �y,�.; .tr , .���� � �', " �� ��-= � .< ���= ,��� � . <br /> Will this be a Parade of Homes, Remodelers S�tiowcase Home or other Disp y Home? ❑ Yes � No <br /> If yes, a specia/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 nof be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � _ t - <br /> L Y 1. .� ��1�_,. <br /> ._ �-.._.t. �'.. �.� . .. �....... .�� i <br /> State License# Expiration Date: <br /> Phone: (cell) �'; /.� - ,`—�i - 7,3 7 7 (n##��e) �'�.�, ,. �:-�.�i �7.� - �� �'t;� <br /> Mailing Address: i ?_; � �,�> "' Z Cit ' "�-�. ZIP: :,�,_;- ?- <br /> Contact Person: �z�k...,� Applicant is: Contra �r / Homeowner (Circle One) <br /> Email and/or Fax: <:�/-=;-� �;_ � ;� .,1;;�,r.% i -r-�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: � ' <br /> k �c,� �z�;.. •—,:�r� �� <br /> Phone (day): . � �- /� -,��/- �_3 7 7 . <br /> . . <br /> — �� x v�-cL_ . J�c � .c":_ � �- <br /> Address: ��•�� ��, % _ Cit '�"-- ZIP: ��`---� � <br /> Email and/or Fax ;�j✓�� ��<<��F-F-, , � ; <?i� �r� ; /. �'�'i�; � �� <br /> � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <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 detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public [t]-8torage ❑ 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) ❑ pther: (specify) <br /> 18202 Minnetonka Blvd ,( �,;,V.yt L' . ,�Y ,Q�4 <br /> Deephaven,MN 55391 ; <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ `"�� � �� / <br />