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,� CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: ZO I(� -� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —�- �p <br /> StreetAddress:' Received by: <br /> y�.` G� 2750 Kelley Park y2�) _��Cj Plan review fee: (p� •j� <br /> qkESHo4�" Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and ail required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: f�,���-�C h �,r �,�, �r(V�. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes,a specia/event permit is required with Po/ice Department and City Counci/approval 60 days prior to the event. Shutt/e 6us service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRAGTOR/ . PLICANT INFORMATION: <br /> Name: �r{C( i (� <br /> State License# Expiration Date: 3 31 � <br /> Phone: cell) -- - office) �3-35�`52 ' <br /> Mailing Address: 2,D h �1� , Cit :�i �,� ZIP: <br /> Contact Person: ���� ��p��,��C., Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: �j �(� p�z��P,(,k.S,�.��'Y� <br /> PROPERTY OWNER INFORMATION: <br /> tvame: ?►�.�,�,K.Clt'�C;�, 1=iC�.�`l�,YII'1� (�IOi�i�ISC�h <br /> Phone (day): -- 5'2�1 <br /> Address: I���� P��v-QJ City: �'��(�[1 ZIP: �C���� <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: Description of project: I� ��� ���,� ��C�. �f'- '�.J�J- /��7�� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. ewage 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) ❑ 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) ❑ Othe�: (speCify) ❑ Othe�(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) $ I�I���" <br /> Last Updated: January 2016 <br />