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� � <br /> .f ; . <br /> ' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: �� d// <br /> � f V� CrysBtal Bay, MN 55323-0066 Date received: / -�-� '"�� <br /> Street Address:' Received by: T N P <br /> y �� 2750 Kelley Parkway Plan review fee: a� !(p -� <br /> F ,,�'"� .�o_ 7 9 <br /> !�'�fS H��� 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � 1 <br /> Job Site Address: �rj �.�,N(,M �Q��L, pQ.�1/� , OeChl� , M N cj5��_ <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 approva/60 days prior to fhe event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site partcing is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �• T�yta11 pG�St�i1J � "n M Jo�cnrSarJ <br /> State License# Expiration Date: <br /> Phone: cell t office • 30�Z- <br /> Mailing Address: Z383 �� Cit • Z.O <br /> Contact Person: M Jp!{N N Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: KN L � . CD <br /> PROPERTY OWNER INFORMATION: � � <br /> Name: L NE �tSM <br /> Phone (day): a . <br /> Address: Z� -�j � Q�11� Cit : ZIP: 553�� <br /> Email andlor Fax E WL <br /> ARCHITECT!ENGINEER INFORMATION: <br /> Name: (`t V IL tJEStC�� P12d�i�..�61flN�N.S <br /> Phone (day): �, . <br /> Address: S. Cit : nA�NM�LIS ZIP: �.r4-Z-fl <br /> Email and/or Fax: Ef�J I — <br /> PROJECT INFORMATION: Descri tion of ro'ect: M.'� VI� �UL/�� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal �1 <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) �01�l.p��- ❑ Multiple Family/Condo �Retaining Wall(s) <br /> yV 1�.�,,5 ❑ 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: (specn/ ;fy� ❑ Other(specify) <br /> 15320 Minnetonka Blvd ( <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 �A'� K�t;�V'til'�U <br /> Fax: 952-471-0682 <br /> www.min nehahacreek.or <br /> A 0 0 0 SEP 2 6 <br /> Estimated Construction Valuation (excluding land) $ �-I t <br /> � CITY OF ORONO <br /> Last Updated: January 2016 <br />