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<br /> CITY OF ORONO ����, ��
<br /> BUILDING PERMIT APPLICATION I
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> �O A, Mailing Address: Permit number. 7�/�-�(� z
<br /> �VO !qJ �� PO Box 66
<br /> `� � Crystal Bay,MN 55323-0066 Date received: 2 �-7 —� �
<br /> �,�'' - Received by: ��
<br /> y � � StreetAddress:' � � ,� I� _- _._ _ , -�--- _ `
<br /> �. G� 2750 Kelley Parkway �t;(�p Plan review fee: v�
<br /> !qk£S H O�� Orono, MN 55356 ��� �-�� �� - -... � '
<br /> Main: 952-249-4600 Total Fee: LS /
<br /> Fax: 952-249-4616 wv✓w_ci.orono.mn.us J (,l'(�J�
<br /> This application form must be completed in full and all required infoRnation must be submitted.
<br /> Incomplete applications will be returned. (Please print)
<br /> GENERAL INFORMATION:
<br /> Job Site Address: j; , - �;�, �, ,{
<br /> Will this be a Parade of Homes, Remodelers Sho case Home or othe�Display Home? ❑ Yes o
<br /> If yes,a special evenl permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle 6us service wil/be
<br /> required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events wilf not be a!lowed.
<br /> CONTRACTOR/APPLICANT INFORpAATION:
<br /> Name: �r s� — �cc�<.r �;;�s�^����- �� /�t,�.�,�,x,..t=.� ,ric_
<br /> State License# F,G �,�t g ;3� Expiration Date: ,��,��-
<br /> Phone: (cell) �/5� �� 7- l b�7 (office) 7� 3 -ac� -�>>c�
<br /> Mailing Address: �� �.wu:� s� .v,� City: C II� 4:vz.- ZIP: �5 3 t
<br /> Contact Person: �s� �-���.1t,,.��x Applicant is: ��/ Homeowner (CircleOne)
<br /> Email and/or Fax: � v� T /
<br /> .,Z�SC � f c C%�i v r, 1,��.:�S �'-���-�t�, Y✓I✓7. L�%/'✓�
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: �'�,t� �� �.;;,�x I�sS
<br /> Phone(day): 6�3 � �a9� 5�'!o E
<br /> Address: �1���( L�(�.2 5h�;,,�z ikl,�; City: r�nit� j>(µ,� ZIP: 5 5 3 5�
<br /> Email and/or Fax L.c��e y��, ��% �:�,{,,,,,�_; ( � c_r��--
<br /> ARCHITECT!ENGIN�ER INFORMATION:
<br /> Name: � ,� t'1�.,�,�.�.t =
<br /> Phone(day): '�� ; 7.�s� - G oC `i
<br /> Address: ��;2`I �,,�,h�.t �-i,�; City:S�'r;�., Lk �� (c ZIP: 55`�3a
<br /> Email and/or Fax: _�,� j/:�
<br /> T j
<br /> PROJECT INFORMATION: Descri tion of pro'ect: 1�f��-'�-' -- -
<br /> 1.Type of Project 2.Proposed Use 3.Structur Type 4.Sewage Disposal 8
<br /> Water Supply
<br /> ,�New Construction �ngle Family with ❑Accessory Bldg./Garage
<br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer
<br /> ❑Accessory Building ❑ Singte Family with ❑Office/Commercial
<br /> ❑ Relocation detached garage �'Residence �Private Sewer
<br /> ❑Other: (specify) ❑ 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 8 permits. ❑ Industrial ❑Warehouse �Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑Othel':(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 /> Estimated Construction Valuation (excluding land) � i�, �'Z�;`�� .��"j��,C'��;��:
<br /> �+�-� ,�—�';,,-;�,�-
<br /> .,� � Mo���� (����..
<br /> Last Updated: January 20J6
<br /> � d1 Z � Z� — � �
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