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� �I 1���i�" <br /> CITY OF ORONO <br /> ' �' �', � Ix <br /> BUILDING PERMIT APPLICATION �Yfi ,s��ir�° <br /> -�'1 �, �.�. <br /> FOR NEW STRUCTURES OR ADDITIONS 'r d� �3 <br /> � <br /> �O A,O Mailing Address: Permit number: 02�/�O-- S <br /> 1 V PO Box 66 ��7 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> � � Streef Address:' �Q� <br /> �' G�` 2750 Kelley Parkway lan review fee: O �. � <br /> � � <br /> t9kESH��� Orono, MN 55356 �� _ J Q <br /> Ma i n: 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�j�� � � <br /> Incomplete applications will be returned. (Please print) 7 , <br /> GENERAL INFORMATION: 1�,��� Cj,�l�� <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 availa6le. Non-permitfed events wil(not�b�allowed. <br /> p: <br /> CONTRACTOR/APPLICANT INFORMATION: �� �� <br /> Name: �0 Q.i a N I-b 1+�ES " `i ` ° <br /> State License# 'PjC (�3� 22„� Expiration Date: M� — �'j <br /> Phone: cell office Q <br /> Mailing Address: $ Cit : t, �td ZIP: 5 <br /> Contact Person: C l�4R15 NO KTo+v Applicant is: nt ac or / Homeowner (Circle One) <br /> Email and/or Fax: GI�R�g�( Q IJOR.Tor(NaM2� CON� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ` l �� uC�P� �S <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 'PphrJ f�'E22,p6, <br /> Phone (day): 6lZ- S 97^�Z69 <br /> Address: City: ZIP: <br /> Email and/or Fax: E o�1 G /� H C� nT �k 1�• Coh� <br /> PROJECT INFORMATION: Description of project: �C,� �� ���' �-�� <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 Bidg./Garage <br /> �Addition attached garage �Deck � ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ 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 <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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 5� �O� • Oc� <br /> Last Updated: January 2016 <br />