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. � . � , <br /> ���, �] REC�IVED <br /> CITY OF ORONO� OCT 0`� Z016 <br /> BUILDING PERMIT APPLICATION C�N pF ORONO <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: Permitnumber: ('/ —�� � <br /> PO Box 66 <br /> � <br /> Crystal Bay, MN 55323-0066 Date received: �- -- (p <br /> ��, �,, Street Address:' 7� <br /> Received by: 1/ <br /> y�. � 2750 Kelley Parkway Plan review fee: ii, <br /> �qkESHo��G Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: ���G d� �,� , <br /> Fax: 952-249-4616 www.ci.orono_mn.us � ""_���; ;��� r1 , �� ��� r,•,-; , <br /> This application form must be completed in full and all required information must be submitted. Y;: ��,�-- <br /> Incomplete applications will be returned. (Please print) s , ��, � -f <br /> GENERAL INFORMATION: r� <br /> Q',�I _ � ,�+�, � , ���,_���-'. <br /> Job Site Address: ���.,�1c� c�if 3<-�., r�:.;h_- ��� �'�V �.rc, � f � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [}t�"o <br /> /f yes,a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutt/e bus service wil/be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��� .1 ��� �-F--,r�; C,=�.lr�r��rt- �� � f�-"— <br /> State License# � �� �{r�.� ��Q Expiration Date: <br /> Phone: (cell) �'��2 - �-}y�} - c�i,��} (office) <br /> Mailing Address: ,U. ' �-�=��-�:C�nl� ZIP: +_ == ' ;�?;� <br /> Contact Person: � ^ � Applicant is Qptracte� / Homeowner (Circle One) <br /> Email and/or Fax: , ,�,�� . �,,v-, <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���-t ��► � �As �� I� , ...i ��-. �7(0.3- 37� ' 7�� <br /> Phone (day): �tts �K _T3QY�(�2�f- �lvd YV1� �j�(�� <br /> Address: (p Z -�{-( _ 2 Q. � Cit : ZIP: <br /> Email and/or Fax �14i S� • yy�Q�,�, •`�� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: l.._ ► TT r- r)J ��..-� ��h� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction ingle 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 8 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) $ ���' r � ��` � <br /> Last Updated: January 2016 <br />