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} Y' CITY OF ORONO <br /> !► <br /> BUtLDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O,� T Mailing Address: Permit�humber_ �l ;� <br /> 1��0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date`received: ;� j'; <br /> y ,� Street Address:' / ` � ` ' <br /> t G� 2750 KelleyParkway Z�l � (,y( PI n:reviewfee � . ��:,.;. <br /> .� �. Orono, MN 55356 � <br /> k�SH°� Main: 952-249-4600 <br /> Tota l`Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> .. : . <br /> . <br /> This application form must be comple�ed in full and all required information rnust be submi#ted`. <br /> lncomplete applications will be_returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ���,j �(/ US"� S�Y�f <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> lfyes,a special event permif is required wifh Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicanf demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APP_L,ICANT INFORMATION: <br /> Name: l»or�vr� �-o�-?�S, L � � <br /> State License# BC (�3Sr�--I Expiration Date: 3-31 -/ 7 <br /> Phone: cell / }- 3Sf(o, � office �fo . S.S�-3. q/ <br /> Mailing Address: / $�a--! �- . Q Ci : r7yat/ ' SSy�-1 <br /> Contact Person: ri p� Applicant is: ontractor / omeowner (Circle One) <br /> Email and/or Fax: � ,r%� n COM.. <br /> PROPERTY OWNER INFORMATIO <br /> Name: „�OUr'C�_ �� �.W�{c�o�ne.z�" <br /> Phone (day): _�fo3SSt.- D/dp <br /> Address ��2/s y�T'� �,�z �/ Cit : •,rJ-[, ZIP: <br /> Email and/or Fax ,,$'�/r�/�d;���� <br /> ARCHITECT l ENGINEER 1NFORMATION: <br /> Name: , Br��e �G�cr�i-..� <br /> Phone (day): �1�3.,'S,�.S'•.??Y�'__`—� <br /> Address: . ��' (° cr i a. City: CI'LJc�I'�'i0 ZIP: 7�s��� <br /> Email and/or Fax: � Q,!-id p, ��y,,�, ' T � <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type o Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> � ew Construction ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑ Office/Commercial <br /> ❑,Relocation detached garage ❑ Residence <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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 ❑ Private Well <br /> ( ) ❑ 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) $ �DD�p0 <br /> Last Updated: January 2016 <br />