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. CITY OF ORONO <br /> - BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���� Mailing Address: Permit number: "�-' I r�-- l i �:���� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �L� � I � <br /> Street Address:� Received by: ��� � <br /> y�, G�'� 2750 Kelley Parkway Plan review fee: �; �' - <br /> tqkESH�4� Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: �'S <br /> Fax: 952-249-4616 www.ci.orono.mn.us �-- ��� ' <br /> This application form must be completed in fuil and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) ��,� �.- °:,� ���C�y�� <br /> GENERAL INFORMATION: ��� <br /> Job Site Address: iy � C.�.�- s��� �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. 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: 5h�vw t„1,'ti kkr <br /> State License# N�,q Expiration Date: <br /> Phone: (cell) ��Z g�co 39G9 (office) �.l�A <br /> Mailing Address: Zy o C.�cw+�• sr�v Dr. Cit : ,,.o ZIP: SS 3 <br /> Contact Person: 51�.�„n Applicant is: Contractor / Homeowne (Circle One) <br /> Email and/or Fax: 5��,,,.,�„�,,,;.=,I�lar� ho+„�,,.;1 . carn <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ _5�-�- as rl5ovc.. <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �,J�q <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Pow��r �� �.w�o��, � N1�.s-f-c� $�,-ty,. (�,MoJc,,C� <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 /> Q Other: (specify) �l�v►or Qs�w�o�c.A ❑ 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:(speCify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> :.J <br /> Estimated Construction Valuation (excluding land) $ i ,�,�� <br /> Last Updated: January 2015 <br />