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• CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> /�� Mailing Address: �- <br /> ��` �� PO Box 66 � Permit number: �� �� � ,��— (:�C;'�� � <br /> , <br /> Crystal Bay, MN 55323-0066 Date received: �--�' 1 ! �'�' � �5 <br /> .� � StreetAddress:' Receivedby: � �_'� � ' � <br /> ___,. . ____ �1� <br /> _- __-------- , —._._. <br /> �` 2750 Kelle Parkw �� �� <br /> y� �� Y ( C' _ �] Plan review fee: . � - a <br /> t�kESI-i0�� Orono, MN 55356 ��,`� �'L � _� _�T��__ �-� <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: ��Z S }��-�..�-�,���� �����` �� S S :3`t � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot Display Home? ❑ Yes (� No <br /> If yes, a special event permit is required with Police Department and City Council approva!60 days prior fo the event. Shutfle bus service wi/l be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-pennitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: ��� �U� �� ����'v�`�" •�'J`� P�c��,`��`� �+� <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: �. p � .c.r Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: c, w � � t <br /> PROPERTY OWNER`INFORMATION: <br /> Name: C �r'�w-�S�v�.. c^ � , ��.r•y <br /> Phone (day): ` �Z,., .��-3 � - �5 iQ'Z-. <br /> Address: ��-1 S` ��..,..,.,,G,.,.. �''�,, ^.;.,.� Cit : ��{�y�"�-c,, ZIP� �S�'� 1 <br /> Email and/or Fax _C„��w-.�-�y � �b�C�, ��. <br /> � <br /> ARCHITECT/ ENGIN�ER INFORMATION: <br /> Nam e: 1 v..r.,.�,,. �.�,. � �c.S� .�,. � � <br /> Phone (day): (763 �{ +-f-. pq�t "� <br /> Address: � p� t+��.�, J�e.J `...c�„�. �,�r 1-�-, Cit : "� � w,nk� ZIP: S'S��{ � <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with �Accessory Bldg.!Garage <br /> ❑ dition attached garage ❑ Deck <br /> Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> 9 y ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence rivate Sewer <br /> ❑ Other: (specify) ❑ Multiple Famity/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. ❑ In�lustrial ❑ Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) [,�}`Sther: ec fy) ❑ Other(specify) <br /> 15320 Minnetonka Blvd ��,�.�,\, �S`��,��„` <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation {excluding land) $ Z..oa� oa� <br /> Last Updated: January 2095 <br />