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' CITY OF ORONO <br /> � BUiLDING PERMIT APPLICATION � <br /> , <br /> �o�. 3 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � <br /> OA,. Mailing Address: Permit number: 0�0[ lo' C7�3 � <br /> � �VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: - J`-� � � <br /> ,a Streef Address:' �. Received by: }�� �I '� � <br /> �'�n` G� 2750 Kelley Parkway .���� Plan review fee: ��� �O <br /> �'�ESHOR� Orono, MN 55356 � <br /> Main: 952-249-4600 �� ��� 33 <br /> 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: �60 �� �- �, 5 (� � -�-a (/V(� �5�� � <br /> Will this be a Parade of Homes, Remodelers Showcase ome or o er 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 availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP ANT INFO ATIO : <br /> Name: � �, �,.^, l � ,�,��p. <br /> State License# C.. 7 Expiration Date: 3 <br /> Phone: cell -ZZ l - office <br /> Mailing Address: Cit : Q � � ZIP: / <br /> Contact Person: ` � Applicant is� ontract / Homeowner (Circle One) <br /> Email and/or Fax: � ` � � ,C <br /> PROPERTY OWNER INF RMATI N: <br /> Name: � Z� <br /> Phone (day): Z- � <br /> Address: O Cit : C�{�o�C� ZIp: S ��.�� <br /> Email andbr Fax 2 � �, <br /> ARCHITECT!ENGIN��INFORMATION: <br /> Name: �}• <br /> Phone (day): <br /> Address: City: ZIP• <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 8� <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer <br /> ❑ Relocation p detached garage ❑ Residence ❑ Private Sewer <br /> �Other:(specify)1�-�"ioC fck�DJu� ❑ 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 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eci ❑ Private Well <br /> 15320 Minnetonka Blvd � p �� ❑ Other(SpeCify) <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(�_QQ(� Q� <br /> . <br /> Lasf Updated: January 2015 <br />