Laserfiche WebLink
—�, <br /> CITY OF ORONO �d ����� �c'� <br /> - BUILDING PERMIT APPLICA I N <br /> %� l�tPb�{ <br /> , FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number. ��(�l�p �l`� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> �, �, Street Address:� `� <br /> Received by: /�� <br /> y�, G` 2750 Kelley Park y ���� —bl.�7 lan review fee: � , <br /> �qk�'SH��� Orono, MN 55356 � � } _ ____�--- <br /> Main: 952-249-4600 Tota1 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 submitted. <br /> lncomplete applications wili be returned. (Please print) <br /> GENERAL INFORMATION: <br /> �ob Site Address: 1225 DICKENSON 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 /> NaOe ERTY OWNER �N TOM GIEL' �- St�lrah Ca121 �Q�L ' 1�j' " �7� 3 <br /> Phone (day): ��Q N� 55356 <br /> Address: 1225 DICKENSON STREET Cit : ZIP: <br /> Email and/or Fax �r0�j���,(�� <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 ainin� wal! ❑ 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) � ����v� <br /> Last Updated: January 2016 <br />