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� CITY OF ORONO <br />' ' BUILDING PERMIT APPLICATION � <br /> �o�• 3�- <br /> FOR NEW STRUCTURES OR /�DDITIONS <br /> ��� Mailing Address: Permit number: c�0� �o ' C�C�� �� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � - 5' � �v <br /> Street Address:� <br /> Received by: }�� �! � � <br /> y�, Gti 2750 Kelley Parkway �1��� Plan review fee: ��� � <br /> tAkESHO�� Orono, MN 55356 � ,�� _ ., �� �,_� 33 <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: S6� ��-�.�- ��c�_(,t����-�-�, (/�� �j 3�j � <br /> Will this be a Parade of Homes, Remodelers Showcase ome or o er Display Home? ❑ Yes �N-o <br /> If yes,a special event permit is required with Police Department and City Counci!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/AP ANT INFO ATIO : <br /> � <br /> Name: �; l ` ,�,� <br /> State License# C. 7 Expiration Date: 3 <br /> Phone: cell -ZZ! - office <br /> Mailing Address: Cit : Q c t,� ZIP: 3 / <br /> Contact Person: ` � Applicant is� ontract / Homeowner (Circle One) <br /> Email and/or Fax: ' ` � � .�G <br /> PROPERTY OWNER INF RMATI N: <br /> Name: � Z e <br /> Phone (day): Z- - � <br /> Address: p Cit : O{�o„�� ZIP: �j ��}.�`� <br /> Email and/or Fax Z � �, <br /> ARCHITECT/ ENGINEFIj.,�VFORMATION: <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 � <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 D � detached garage ❑ Residence ❑ Private Sewer <br /> �Other:(specify)�.r��cC FCKD�U ❑ 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 ❑ 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(�.QQQ .Q� <br /> Last Updated: January 2015 <br />