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' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION C� 37S�k� <br /> FOR NEW STRUCTURES OR ADDITIONS ��� � <br /> �O A, Mailing Address: Permit number: p�6�7 <br /> `wO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �"—� <br /> �, y Street Address:' <br /> Received by: � <br /> �'�. G: 2750 Kelley Parkway b� �� Plan review fee: � � � <br /> `qkESHO�� 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �5 n.. �r��_ r <br /> Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes No <br /> If yes, a specia!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 su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 5 c�,h �S a r.j ` <br /> State License# f: ��.��s� �„ Expiration Date: � <br /> Phone: cell �ri Z. . � — — office (,, • �{ . � �,G <br /> Mailing Address: / � Cit : (�l �.,`c-� ZIP: �� � <br /> Contact Person: ! �'�r,�. '�,.J Applicant is: n ractor meowne (Circle One) <br /> Email and/or Fax: ur ' � �,,; ,✓ �-._ � <br /> PROPERTY OWNER INFORMATI N: <br /> Name: <br /> Phone (day): - <br /> Address: �S � �v+t_ Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMAT ,N: ^ ' ) <br /> Name: �,►, �- �d,�,5 i N <br /> Phone (day): �, . � � �,o <br /> Address: �/pC2 (.�� !-�,��e ��-_ City: ����� ZIP: S,j`{y y <br /> Email and/or Fax: r h,{�e� ����,(�< <�,,,' . <br /> PROJECT INFORMATION: Description of project: ' "�� ���— <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> �New Construction Sin le Famil with Water Supply <br /> Addition �attached garage ❑ Deckssory Bldg./Garage <br /> ❑Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ 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) � ��s�'] <br /> Last Updated: January 2016 <br />