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CITY OF ORONO o�S� /�J <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: Z���0 "� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —�— �p <br /> �l� StreetAddress:' Received by: � <br /> y�, G� (,��� 2750 Kelley Park y2UI�_W� -�j Plan review fee: (O� •� <br /> �qk�SH�R� J 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 all required information must be sub 'ted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: f��,�fr�.��CI(1 l;l'��� ��j\��, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service w�ll be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/ PLICANT INF�ORMATION: <br /> Name: �r�C,(` i . v <br /> State License# ��r��?�,7�� Expiration Date: 3 3� <br /> Phone: (cell)�-(�?,-Ly�—� 7�j (office)�3-355`5233 � <br /> Mailing Address: 2,D r �'� �l�j , Cit :�� ,�,�'� ZIP: ) <br /> Contact Person: ��(� J'"��,��k, Applicant is: ontracto / Homeowner (CirGe One) <br /> Email and/or Fax: j�����p`iC�PC����.�V� <br /> PROPERTY OWNER INFORMATION: ��r u ���Yl ) <br /> Name: 1 Yl;�,!",�C.,C1.i'1C�, �C�,f�l�rlrl�.� (��i�r1SQ�'1 <br /> Phone (day): ^ .j�G�l <br /> Address: IZS� �1'Q�l� �,YQ,Q.�, �j�� City: �(�(�� ZIP: ��j�J��I <br /> Email and/or Fax 10�2—' �5�?q�"7 (G� �l�t.�.. <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(� ��I I n�.�ti� ��C�. �{'� I��,j�J- �7T�2-C`� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. ewage 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 b�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) ❑ 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) $ I�!���a <br /> Last Updated: January 2016 <br />