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/ <br /> � �- CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: l — <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a ,, Street Address:� <br /> Received by: <br /> y�. G� 2750 Kelley Parkway Plan review fe � <br /> ��kfsHa�`�` Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: g �/ � <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: �y�� �,�a,,,r �y 5 <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. Shutt/e bus service will be <br /> required unless applicant demonstrates su/ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �lex�, P.Qv�S�vr,L�c, <br /> State License# R�6'�90�-� Expiration Date: 3�3i��o�k <br /> Phone: (cell) 952-6��-`�-9 (office) �iz-4�z-�iboa <br /> Mailing Address: �53 L�-k�, � Cit : zo.l�, ZIP: sS391 <br /> Contact Person: Aleu LGh� Applicant is: C tor / Homeowner (Circle One) <br /> Email and/or Fax: �,��� ����S;o�v�,r�.��„�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: T,n•�}1,� c.�AMti S�II����r <br /> Phone (day): <br /> Address: ytio �co,�,n 1�, S City: oCoro ZIP: SS39� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: 4.01 �e € 1,a��. l,��c�, , .� ;,� l w.ew� <br /> 1.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) �,�,t�� �„TiYIowS ❑ 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) $ !-2� U��v <br /> Last Updated: January 2016 <br />