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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR EW STRUCTURES OR ADDITIONS <br /> �O A ,O � MailingAddress: Permit number: G��� �� a <br /> ��� PO Box 66 � <br /> Crystal Bay, MN 55323-0066 /�� Date received: lJ�"� <br /> �\� O�1' Received by: � <br /> Street A ddress:' <br /> yF G� \�\ 2750 Kelley Parkway � \� Plan review fee: � L� <br /> CykfsHo�� Orono, MN 55356 �Ol��D��� <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us �(x�yy�/ <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: I��c' �7r:�c'�ur-�� l�:-��+`��l�✓�?N►� �ti'� ���3�i+ <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO : <br /> Name: '' (,,� - � �. t�� , <br /> State License# �3C (�;3 5 2�S Expiration Date: 3 3i �-C�l7 <br /> Phone: cell C.12--2i�Z-�f3�i 3 office r� i 2-��t-4y 3c� <br /> Mailing Address: /�U�,;v Z3' Cit : P( yr,c� � ZIP: '���F 7 <br /> Contact Person: �f�j�,n Applicant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: ;�,�,,�ny_�L c. �a�(�>c_v c1��� �� �-.. <br /> PROPERTY OWNER INFORMATION"�• <br /> Name: ��.�,r'�,J f"1"Z y�,a r:��� ��irU`��'. <br /> Phone (day): <<`- �,I - ( L <br /> Address: Zar,: - � Cit : M�� ZIP: ��3��1 <br /> Email and/or Fax � , I� •� ��a� -/• t.c�:� <br /> ARCHITECT/ ENGINEER INFORMATION: _ `� / <br /> Name: C:,har�y .�car3 �v ' rrznl-� 74�n1i.�-r /�,c,�°��a�c� �/�re-Giu�r�y�k�.,�� wjz-3�i-�t�65 <br /> Phone (day): �z-3� - 3�� <br /> Address: y�+� ' �" Cit : �� pnc,;� ZIP: 554'f'7 <br /> Email and/or Fax: �',v� `" �.l��ri�r�s���c�c•c�.v� <br /> PROJECT INFORMATION: Descri tion of pro�ect: 5cvz���� �7rc h <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) `��r�z�n Pj���" ❑ 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) ❑ Othef: (speCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd /V,/Q <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �_1, ���n <br /> Last Updated: January 2016 <br />