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, <br /> � ' . CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> /�O�,� Mailing Address: Permit number: ��`�O— � <br /> `VO�� PO Box 66 ���� . <br /> � Date receive� � �i�� <br /> % � Crystal Bay, MN 55323-0066 <br /> i y :,�,l2 , <br /> j .� t ,, � Street Address:� - -- �ived b : <br /> �,�yfi ��� 2750 Kelley Parkway /� '�n review fee: �__ , , <br /> ����.F.sH���`� Orono, MN 55356 `' � " �a ! _ , <br /> �_.___^-- Main: 952-249-4600 Total Fee: --- <br /> Fax: 952-249-4616 v✓�,°,n�v ci.��ono 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) �I I p�J <br /> GENERAL INFORMATION: l„ / � <br /> Job Site Address: �� �-��1,i�1� � �� �l� <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 Ciry Council approval 60 days prior to the eveni. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permiited events will not be allowed. <br /> _._....... _______-._; <br /> CONTRACTOR/APPLICANT INFORMATION: � ---� <br /> Name: ��}1 -D,4'L. — �C�ll� i'�C�V 15L <br /> State License# gC(���021 ` � --�--�-�-�--�- Ezpiration Date: � � <br /> Phone: (cell) G5Z-s`�� - —f� `� (office) (�IZ-�(Q,2-`�txx� <br /> Mailing Address: ly3 L[� S�r E Cit : W �T� ZIP: =�?q <br /> Contact Person: IC��t�,J suu1.-f7 Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: ��li;J ��2�l�sior�I rM� CD� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �N�}��I p�spn g�-�-� <br /> Phone (day): <br /> Address: �(�S 126� � City� ��j� ZIP� �'�3`�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /�-f�CA�I��I�I� �i12�JP =TDIK �i_-t�`T� <br /> Phone (day): <br /> Address: City� ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project /`���� � �� �-7a `C,���-- <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with �.Q,ccessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Other (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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 atTa„�c-.� �t�.ZL <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> vdvrw minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � ��� <br /> Last Updated: January 2016 <br />