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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> .�O A T Mailing Address: Permit number: �6i,.5'-d/ <br /> �VO PO Box 66 <br /> Crystai Bay, MN 55323-0066 Date received: �o�� �y/5� <br /> �`�Q Received by: <br /> ,� Street Address:' 1n r <br /> 'y�, G� 2750 Kelley Parkway �l�G Plan review fee: <br /> lqkESH�4� Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: � 37, ` � <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: 3� g5 (NS�c ������- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> li 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 un/ess applicant demonstrates sufficient on-site parking is availab/e. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: SdtN l��„���� <br /> State License# �( �a c���s� Expiration Date: ► z -�fs <br /> Phone: (cell) L'2 - z�?- z�`t � (office) G I Z - N�Z-K�� ^ <br /> Mailing Address: I53 �-��- s�' f �-S'� w�z�--r'� +rt City: � �..is7Z�.r-1 ZIP: 5s3�t <br /> Contact Person: 5�,�a Applicant is: Contractor / Homeowner �c��cie ooe� <br /> Email and/or Fax: �,.�N �, �c-�2_ `�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: N�s�� � r�r�.., v�F-�- <br /> Phone (day): �t y�, 5°f S- `�N��' <br /> Address: ���( wy,zh-ry �gi v Z CitY� �r. �r ZIP: S�Z6 <br /> Email and/or Fax . r . �. �� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <i(���.�rt�z <br /> Phone (day): �„y.t .-.�s �-Na� <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 7.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 ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Famity/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 <br /> ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �Q � <br /> � <br /> _� - � n—i 1n Nf� i(2,• '�' 1[�'f N\ <br /> . � <br /> i i <br /> Last Updated: January 2015 <br />