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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � �, 30� <br /> vX� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: - Permit number: � � �o— � � <br /> �VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 � Date received: S��—� <br /> Street Address:� ,I�� (� Received by: <br /> � � 2750 Kelle Parkwa �� �v <br /> �'F �L� Y Y ��`' 1� �an reviewfee: �3Oi FS�O <br /> Orono, MN 55356 <br /> ��kESH�� Main: 952-249-4600 C �j��� Total Fee: a'D� �—� 7 <br /> Fax: 952-249-4616 tvv,��<<.c.i.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 /> Job Site Address: ,5 �� � � <br /> Will this be a Parade of Homes, Remodelers owcase Home or other isplay 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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP LICANT INFORMATI N: <br /> Name: � L <br /> State License # Expiration Date: <br /> Phone: cell (o - office <br /> Mailing Address: Cit � n � ZIP: 5 � <br /> Contact Person: -� n Applicant is: Contractor / Homeowner �c�r�ie o�e� <br /> Email and/or Fax: �yV�� �g� M Sn c�ru <br /> PROPERTY OWNE IN OR ATIO p )� <br /> Name: ���. �-�'� `�.�D,�fL- <br /> Phone (day): (,�Z �`? �o�� <br /> Address: GS a Cit : C/Y��lC7 ZIP: <br /> Email and/or Fax 1'1� I 2- �� QO�•(11Y✓� <br /> ARCHITECT/ ENGINEER IJVFORM TION: <br /> Name: -���^v ►v�-�-S <br /> Phone(day): <br /> Address: a Cit :� }�'la'��e,�.�� ZIP: 5,5� 7 b <br /> Email and/or Fax: r � �, <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <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 <br /> ❑ Other:(specify) L ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ Retaining Wall(s) <br /> ❑ Pub►ic 4-feet or greater ❑ Public Water <br /> '*Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well <br /> ( ) ❑ 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 /> Estimated Construction Valuation (excluding land) $ j(�,DDr? �,fl <br /> Last Updated: January 2015 <br />