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` � CITY OF ORONO � � <br /> � o��, <br /> BUILDING PERMIT APPLICATION ,�� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • _ Mailing Address: Permit number. �< �"" d <br /> ��l PO Box 66 � <br /> � Crystal Bay, MN 55323-0066 ���1 Date received: � � : <br /> � Receiued by: _ �L� : <br /> Street Address' �� <br /> y � 2750 Kelley Parkway �0� � Cl' PI n review fee: �y, <br /> t �,�' Orono, MN 55356 ���,-.-�-�-; <br /> �kE5H0� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in full and all required information must be submitted:: <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: , -7 <br /> Job Site Address: � /�S _ �l� US�- S�� <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 requrred with Po/ice Departmenl and City Council approva160 days prior to the event. Shuftle bus service wil!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permifted events will not be allowed. <br /> CONTRACTOR/APP_L,ICANT INFORMATION: <br /> Name: l�or�vr� �or�-?�S L � � <br /> Ex iration Date: 3�3/ - / 7 <br /> State License# 8 C �35�--�--I — p <br /> Phone: cell f 1-- 3$(0- � office ��o . S.S�'- 9/ <br /> Mailing Address: d $�0�-1 � . /J Cit : rlia/ ' SSy� <br /> Contact Person: re Or Applicant is: ontractor / omeowner (Cirde One) <br /> Email and/or Fax: G r� /t h C4M- <br /> PROPERTY OWNER INFORMATIO <br /> Name: .�O�Jr��_ �- (�-C✓'e�c�°rn�'c�" <br /> Phone (day): _`�3SSl� 0%OQ <br /> Address 12�=1-/5 y�T�' /�✓z � Cit : •:�-/-� ZIP: — � <br /> Email and/or Fax �`z SUc/r�G�a+i d-�C�+"� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: . ,�Yv�e �GG�i.�r•- <br /> Phone da S S•_ Y y�� <br /> ( v)� _21�;3�. ,� �?Y.� <br /> c�t �/�S{� ziP: SS��7_ <br /> Address: . .1�� � cr � a Y �� — <br /> Email and/or Fax: i cLh.o o. �cv�-�. � <br /> PROJECT INFORMATION: Description of project: — <br /> 1.Type o Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Water Supply <br /> � ew Construction ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Familywith ❑ 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) $ �DO�p 1 <br /> Last Updated: January 2016 <br />