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r <br /> ' . ' � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��� Mailing Address: Permit number: �Ql�Q— � <br /> � PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date receive��� � �e <br /> y a StreetAddress:' -Reeeived by: ',C.� <br /> F '� 2750 Kelley Parkway � �n review fee; , <br /> t�,�-FSx����'�* Orono, MN 55356 �a ` _ <br /> _.. <br /> Main: 952-249�600 ---- --- - <br /> Total Fee: ---- <br /> Fax: 952-249-4616 w�,�v.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: ��j ���,f�l� � �,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> lf yes,a special eveni permit is required with Police Department and City Council approval 60 days prior to ihe event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parkrng is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �O}l -�4'1- - ��l►� ��'V15t <br /> State License # $�(¢��p2� xpiration Date: � 2p <br /> Phone: (cell) q5Z-s`�� - �� � (office) n�2-�(s�,2-�� <br /> Mailing Address: 153 S�r E Cit : W �-� ZIP: =<2 q <br /> Contact Person: IC�V�,� sAuL-r7 Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: (�-�1 irJ �I�lts io►.�rM1 C�nl� <br /> PROPERTY OWNER INFORMATION: <br /> Name: `3N,4�I� pts��pE f f��g�`�T- <br /> Phone (day): <br /> Address: �p(�S (� W, City� 012-�?�-1v ZIP� �S3`�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATtON: <br /> ►vame: �}-J�CA-►�11���l�f �,�Jp =TD/� �t--t�`� <br /> Phone (day): <br /> Address: City� ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ���C�-� �a-��c�-- <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with �.�,ccessory Bldg. /Garage <br /> �Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> ❑ Relocation 9 y ❑ Office/Commercial <br /> 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 ��a,�� ���� <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �nnr�w.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �j ��� <br /> Last Updated: January 2016 <br />