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, � 5�� �� <br /> CITY OF ORONO --------------- <br /> BUILDING PERMIT APPLICATION �� � 7Slk � <br /> FOR NEW STRUCTURES OR DDITIONS �5��`'' � <br /> �O�O Mailing Address: /1 Permit number: t��� 7 <br /> PO Box 66 <br /> C rystal Ba y, MN 55323-0066 ��1� ` Date received: � '� '"— <br /> Street Address:' <br /> Received by: � <br /> y�, G� I 2750 Kelley Parkway ��' �� Plan review fee: ��_ � � <br /> �qKFSHo��. 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. (Please print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: ���i� �� � -�.,� r <br /> Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes No <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/APPLICANT INFORMATION: ' <br /> Name: ���:+, ����-,-J �L. <br /> State License# tG 1c�;}��J sj � Expiration Date: � <br /> Phone: cell r.-r� Z 3 - — office ( �{ - - � �Z� <br /> Mailing Address: /' � Cit : �C �.wc;� ZIP: 5 ' � <br /> Contact Person: Jr � 5�� -e-•J Applicant is: n ractor meowne (CircleOne) <br /> Email and/or Fax: ,u� r c,,; .✓� � -�a�'_ L <br /> PROPERTY OWNER INFORMATI N: <br /> Name: <br /> Phone (day): <br /> Address: �S ►��,,C' )a.�_ Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMAT N: n ' <br /> Name: nr, �' r��<<� <br /> Phone (day): �, . ci �,c� ' <br /> Address: ��/O(? �� P{-�a.�.���e 5�' - City: ��.rh�� ZIP: SS`{Y� <br /> Email and/or Fax: C h,�� � ,��P�s«nJ . (s;«�_ <br /> PROJECT INFORMATION: Description of project: � "� �'�"' ���'���'�-- <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal & <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) ❑ 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 (exduding land) $ ,S'��,�'� <br /> Last Updated: January 2016 <br />