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�—. <br /> CITY OF ORONO �� ����� ���'� <br /> BUILDING PERMIT APPLICA I N ��- �U��y � <br /> -- <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: Permit number. ��C�l�G' '�l l0 <br /> ��j V �� �� PO Box 66 <br /> O ( � �( C ry s t a l B a y, M N 5 5 3 2 3-0 0 6 6 Date received: o� � <br /> ,� ,, \/�/ StreetAddress:' ��--� 1 Received by: /ri�T" <br /> y�, � 2750 Kelley Park y �pl(� --Cl.�7 lan review fee: � 's� �` <br /> �qK �ti�' Orono, MN 55356� y--�'`Y°� �C�C�,_,- _ __ , <br /> £5Ho Main: 952-249-4600 � � <br /> Total Fee: <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 submi�d. (� 1 <br /> Incomplete applications will be returned. (Please print) �bJ� <br /> GENERAL INFORMATION. <br /> .lob Site Address: 1225 C)I�K �1 STREET ORONO MN 55356 <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 INFORMATION: <br /> Name: BOULDER IMAGES INCORPORATED <br /> State License# NA Expiration Date: <br /> Phone: (cell)651-260-2337 (office) 651-322-7499 <br /> Mailing Address: 14555 S ROBERT TRAIL SUITE #11 City: ROSEMOUNT ZIP: 55068 <br /> Contact Person: TODD MONTREUIL Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: todd@boulderimages.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: TOM GIEL �+- SQrah GI�� ��L ' 1Q'j ' 27� 3 <br /> Phone (day): p <br /> Address: 1225 DICKENSON STREET Cit : R� Z,P: 55356 <br /> Email and/or Fax ��0�j C Q Q,1�•LPlY1� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <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) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> Boulder re ain�n� wall ❑ Public 4-feetorgreater ❑ PublicWater <br /> **Any earth movement may als 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) $ 30�000 <br /> Last Updated: January 2016 <br />