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CITY OF ORONO �j'`� <br /> �fD <br /> BUILDING PERMIT APPLICATIO , <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number. �G�� - �� L <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006 Date received: �s � , <br /> �, ,, Street Address:� �� <br /> �� eceived by: �Z "(Z- � <br /> y�, G� 2750 Kelley Parkway ���;� ��� Plan review fee: <br /> `qKfSHO�� Orono, MN 55356 ( <br /> � �o��-�;�sz <br /> Main: 952-249-4600 ��, Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.r4in.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: ��(,� i3�;��,v� �� <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 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/APP ICANT INFORMATION: <br /> Name: ���'��,iU'✓� <br /> State License# �tja Expiration Date: <br /> Phone: cell - office - �(lp� -L{t,�Ol:� <br /> Mailing Address: / � T Cit :(..V - ZIP: N ' � <br /> Contact Person: �(�L �.�,�,e1,, Applicant is: Contrac� r / Homeowner �c���ieo�e> <br /> Email and/or Fax: r�i C_lc-, (�v� �� C �� 11'1 r1'I,L��iVI <br /> PROPERTY OWNER INFORMATION: �In <br /> Name: T�wi � ►aw�:� �;,,�:1,�c1c:.�/1 <br /> Phone (day): � <br /> Address: H`1� i3r���� 12.� city: l.�r�rt� ziP: 5���i� <br /> Email and/or Fax }'� �u i�, V�tY�n�1�a�C:, ��ry�Q; I. Ci'�'v� ' SU�ii Vqr�.,Q��y 1� � �1i�1(:� �, ll`w� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro�ect: <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 ❑O�ce/Commercial <br /> ❑ Relocation Y�oDIFY aoQct-4 detached garage ❑ Residence ❑ Private Sewer <br /> �'bther: (specify) 'R�qpF2,AqE ❑ 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) � �%'i(�(j[� Q��TE� <br /> a�c � � zo�s <br /> Last Updated: January 2016 <br /> cinr oF oRONo <br />