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p�j,b� RECEIVED
<br /> CITY OF ORONO DV '
<br /> ��
<br /> , ' ��IE��ItVG PERMIT /�PPLIC�1`IOt� JUN 2 2 ?r���.:
<br /> ��R QVEOl1/ �TRUCTURES OR �DDIl'IOI�S CITY OF ORONO
<br /> /�� Mailing Address: ��`�
<br /> �o` �O PO Box 66 F'ermit number: l(�--L"C_'�,�
<br /> Crystal Bay, MN 55323-0066 Date received: �-o�a—�,�>
<br /> __. Received by: �� /'{��
<br /> .� Street Address:' �._- -
<br /> y�n .'� 2750 Kelley Parkway Plan review fee: � >`a�• d O
<br /> t�kfSH�R�G Orono, MN 55356 � ^ ,;�
<br /> Main: 952-249-4600 � __- --- - ----- ._ _ --�- :��` d"p 7�- "
<br /> Total Fee:
<br /> Fax: 952-249-4616 ���n�r�n�.ci.orono.mn.us �
<br /> This application form must be completed in full and all required information must be ubmitted.
<br /> Incomplete applications will be returned. (Please print)
<br /> GENERAL INFORMATiON:
<br /> Job Site Address: ��,�i��� ��t Sc.0 }�U�
<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 availab/e. Non permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT IPIFORMATION:
<br /> Name: �YUG H�.
<br /> State License # �'-,L 7�,� �a,�, Expiration Date: p 3
<br /> Phone: cell � 6�� 0 q office 25 3 3 ;3
<br /> Mailing Address: '0 +� �,; Cit :
<br /> Contact Person: /(,�u,,� ' �'��'� Z�P� S
<br /> �,tJc�� Applicant is: ontractor / Homeowner (Circle One)
<br /> Email and/or Fax: ,iv�,,,,,� ,m � �-��,� (,��ii,,,l ,�.� ,, f vt,�
<br /> PROPERTY OWNER IIVFORMATION:
<br /> Name: �'�'ocQrit �p�wt.erj
<br /> Phone (day): - q �7
<br /> Address: ' � y�t t� Cit : �� ���� ZIP: 5 S^�fi `��
<br /> Email and/or Fax Q t�o ,,,�cf � c w,.�; • c a tiM
<br /> ARCHITECT/ ENGINEER IIVF.ORMATIOf�,�
<br /> Name: �t,��„��,5 L��c� C o,
<br /> Phone (day): ��Z- � 3 3 - �,o L�
<br /> Address: -'o '� � r� „e, Cit : P I v�1�✓�l� ZIP: �� `'�u 7
<br /> Email and/or Fax: `�.�o��c:> a r�1n�}c�i-y. �c��
<br /> PROJECT INFORMATION: Description of pro'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
<br /> ❑Accessory Building ❑ Sin le Famil with � Public Sewer
<br /> ❑ Relocation g Y ❑ Office/Commercial
<br /> detached garage � Residence ❑ Private Sewer
<br /> ❑ Other: (specity) ❑ 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) ❑ 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) $ 3 Z � � (� O � , D CU
<br /> Last Updated: January 2015
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