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CITY OF ORONO } , � ;�� '� f,Y ��'��} <br /> BUILDING PERMIT APPLICATION . ,;4�� ,<<;-' , �' � � <br /> FOR NEW STRUCTURES OR ADDITIONS '� dl �� <br /> � <br /> �O�O Mailing Address: Permit number: ��/�'- S <br /> PO Box 66 /� <br /> Crystal Bay, MN 55323-0066 Date received: 7 '7—� <br /> �, � Street Address:� - -' �Q� <br /> ti � 2750 Kelley Parkway lan review fee: O �� �J <br /> F�qx�SHo��,�' Orono, MN 55356 � �(p - �Q L� <br /> Main: 952-249-4600 <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 sub itted.6 � � 7 <br /> Incomplete applications will be returned. (Please print) � ,�L�-, , <br /> GENERAL INFORMATION: c° � � 'i'� <br /> � � y�� �� 1���I+�v� <br /> Job Site Address: p � <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. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permifted events wil/not�be allowed. <br /> P <br /> CONTRACTOR/APPLICANT INFORMATION: � � <br /> Name: OQ.� rN � ` ' <br /> State License# 'g�, (,3� 22„ ( Expiration Date: — <br /> Phone: �(cell office) g <br /> Mailing Address: g Cit : � i1q ZIP: � <br /> Contact Person: CF4R.l5 NO�'7�J Applicant is: ontrac or / Homeowner (CircleOne) <br /> Email and/or Fax: ��.�b���J Q N pR.T or(�4nMe5•Co N� <br /> PROPERTY OWNER INFORMATION: <br /> Name: `�.i l �, �;r• r� � � <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 'Pp�yd f'h'E/�2.p6r <br /> Phone (day): 6lZ- S`?7^�Zb 9 <br /> Address: City: ZIP: <br /> Email and/or Fax: E o�/ G� /� H C� nT �k IL• Cc�N`. <br /> PROJECT INFORMATION: Description of project: �C,� �� ��+� ��y'�� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 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.or <br /> Estimated Construction Valuation (excluding land) $ 5, 000 • OO <br /> Last Updated: January 2016 <br />