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, CITY OF ORONO �O <br /> �� <br /> BUILDING PERMIT APPLICATION <br /> � 4 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: �t!! ' �! O <br /> � l VO PO Box 66 Date received: O �S"� <br /> Crystal Bay, MN 55323-0066 <br /> Street Address:' Received by: � � <br /> y�, � 2750 Kelley Parkway i�� Plan review fee: � T• � <br /> � �' Orono, MN 55356 � �/� /�p- <br /> 9k�SHO�� 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�,0� -���£,�� �—c . <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 approva160 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: nu-r � La.p�-S <br /> State License# g Expiration Date: 3-3�- Zo!� <br /> Phone: (cell)'��'�-�lo - '�e4Zq (office) q SZ- q�i.� - b�q 9 <br /> MailingAddress: ��� -r Cit :LoNc.� L/rr IP: S 3SZo <br /> Contact Person: ��.vS �-l.��S Applicant is: ontra o / Homeowner (Circle One) <br /> Email and/or Fax: �,�,�c_�(J p.,�-r�,00�s-,� �,cc.�p�S C.� •-•, <br /> PROPERTY OWNER INFORMATION: <br /> Nam e: M d.�.� 's J s��(rr+� �—+��.a-� c.ti.-�o�. <br /> Phone (day): lp��-30� -�,o�1 <br /> Address: V3.o ��. Cit : o � o ZIP: � q <br /> Email and/or Fax �L�.�t-r r.•� 0 t ���noo C�� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 /> [� ew 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 /> ❑ 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&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.orq <br /> }�- '� <br /> Estimated Construction Valuation (excluding land) $ �(-� �� <br /> Last Updated: January 2016 <br />