Laserfiche WebLink
a � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �0/�-a � g <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� � -� <br /> 1 StreetAddress:' �-----___ Received by: <br /> y � <br /> F G� 2750 Kelley Par . � review-fee:- ~ - <br /> � Orono, MN 553 6 �� _6� � <br /> !qk£SH� � � <br /> Total Fee: 7 �• 3� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us / / ' <br /> This application form must be completed in full and all required information must be su ' <br /> Incomplete applications will be returned. (Please print) ;`��t, '�`�� � �� <br /> GENERAL INFORMATION: � � i v�' � , <br /> Job Site Address: ��`� � �, �" 3 <br /> Will this be a Parade of Homes, Remodelers Sh case Home or other Displa Home? Yes � No <br /> If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil/be <br /> required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events wiU nof be allowed. <br /> CONTRACTOR/APPLIC NT INFO ATIO : <br /> Name: � � �� <br /> State License# Expiration Date: 1 � <br /> Phone: cell o�ce <br /> Mailing Address � ^ - Ci :� ZIP: �j5(:71 <br /> Contact Person: � � , � Applicant is: ontractor / Homeowner �c��cia o�e> <br /> Email and/or Fax: � - <br /> PROPERTY OWNER INFO�MATIO : t�� <br /> Name: � GLt� +r��i'V-('�,{, <br /> Phone (day): 2- � - , <br /> Address: U �,�5 Ci : �} • ZIP: . �( <br /> Email andlor Fax � i . ( <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � <br /> Phone (day): '}-- - c` � <br /> Address: Cit : ��'1, ZIP: �j � <br /> Email and/or Fax: 'K <br /> PROJECT INFORMATION: Descri tion of ro"ect: (� �n�e m�� �Sc <br /> 1.Type of Project 2. Pr osed Use 3.Stru ture Type 4. Sewage Disposal& <br /> Water Supply <br /> �New Construction Single Family with �esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. [+�Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review 8 permits. ❑ Industrial �rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> � <br /> Estimated Construction Valuation (excluding land) $ Z Z �U�•UV <br />