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. � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,--. <br /> /�O�O Mailing Address: Permit number: l�o-� <br /> �/ PO Box 66 <br /> / Crystal Bay, MN 55323-0066 Date received: <br /> � �, , � Street Address:' <br /> Received by: . ��l fiVl.(,� �` <br /> tiF � 2750 Kelley Parkway Plan review fee: <br /> �,ykF�ii����� 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: 2�j�s j�L,r�.�,v,C /�v� Dr�v..Jc� � i��n/ 55.3�J / <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: 6c_,�,-G-c � ✓�.a.+�H av Bc.�.�-F o.� �i%C�� <br /> State License# ,�,,� Expiration Date: — <br /> Phone: (cell) �j �3 45�S /C�2 S (office) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: 5a � �/ � � �,p Applicant is: ntractor I (Circle One) <br /> Email and/or Fax: ve� ���r�s� b�J �I�n� <br /> PROPERTY OWNER INFORMATION: <br /> Name: r�T1 oi� �2vn/O -' �vK�, � �.,1v2�.� <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: 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 ❑ Offce/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> '�Other: (specify) �F Nr/A ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �Eoc,��E n,�`.�i ❑ Public 4-feet or greater ❑ Public Water <br /> "*Any earth movement may also require �Commercial ❑ Storage <br /> MCWD review 8�permits. Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Othef(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wwvd.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ /S ,��r� <br /> Last Updated: January 2016 <br />