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. , <br /> CITY OF ORONO � <br /> BUILDING PERMIT APPLICATION `�/ �5 � ' � � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: r Permit number: o�D� ��J�7/ <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �- � —/ <br /> � �, Street Address:' � <br /> Received by: <br /> �� G� 2750 Kelley Parkwa �q i� Plan review fee: C, ��5. Q <br /> `�kESHO�� Orono, MN 55356 D �o!`_�� <br /> Main: 952-249-4600 Totai Fee: <br /> Fax: 952-249-4616 �v�,-r���.a.orono.mn.us �i���� <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: ���� r� <br /> Job Site Address: �' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � o <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/AP�!NT NFORM TION: `���1� B/v <br /> Name: <br /> State License # G !O Expiration Date: �•'3�• <br /> Phone: cell 2 "� office •�-� d�' <br /> Mailing Address Cit � ZIP: v�'S <br /> Contact Person: Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���� /n/��) <br /> Phone(day): <br /> Address: /,/3S' L`�r¢Zt.1L� Cit :Q/2�j ZIP• <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN ER INFORMATIQN: <br /> Name: �'� <br /> � <br /> Phone (day): • <br /> Address: �n •2� �, ���� City�/�LS ZIP�c�$���Q <br /> Email and/or Fax: _ <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage 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) ❑ Muttiple 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 <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eCi ❑ Private Well <br /> 15320 Minnetonka Blvd � p �� ❑ Othe�(speCify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � � <br /> _ .;�,1-� �n�_ <br /> CIN 0�ORONO <br /> Last Updated: January 2015 <br />