Laserfiche WebLink
CITY OF ORONO � <br /> BUILDING PERMIT APPLICATION ��5`'�� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: � <br /> �- �O PO Box 66 r <br /> Crystal Bay, MN 55323-00 6 Date received: ��- f <br /> StreetAddress:' 1 Received by: <br /> y� � 2750 Kelley Parkway � ��I� 1 Plan review fee: <br /> L Orono, MN 55356 1 I <br /> `q KES H O�� � �� �' �jl'� <br /> Total Fee: <br /> Main: 952-249-4600 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: � �� � <br /> ; <br /> Will this be a Parade of Homes, Remodelers Showcase Home 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 I APPLICANT INFORMATION: K���u1c�2 C��2�3n�- 7f�7� <br /> Name: ���..ER�.-a� �►.�e E��Q�rt+S�vu�t,cK SPoJse) <br /> State License# Expiration Date: <br /> Phone: (cell) - e 1e�2•SI,Z•`7'73 3 (office) 7�-3 ,�� ,. `����� <br /> Mailing Address: t2�,tip �,�y�-� ��r� City: N(,���,'��;� ZIP: S�:3i:5-194 �S <br /> Contact Person: �N ��2��s�_7�,� _ Applicant is: � _` on racto / Homeowner (Circle One) <br /> Email and/or Fax: h�:.hlerlan�-l-��n.����cAc{ c.c�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,, . <br /> Phone (day): ;.,�; <br /> Address: _.. _ City: P��YN�ou�H ZIP: '��,,; ;'., <br /> Email and/or Fax - ��,-{�w�/„�,��- ��r�i r� �� � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ' WA�>��c�t E�� �Tvr��}��;' H� "`��.�.� � � <br /> Phone (day): ;,,� ���{ ' l��,�c� <br /> Address: ;tirrCn���,�n,�z�n�.z�� P : .. . City: R 1 ZIP: • � 's> . <br /> Email and/orFax: andre�c^;,�c�{,�-r r --� • � �F � � - <br /> PROJECT INFORMATION: Description ofproject: �C�S�"�LF ��fG�`� d'tGl�l�-E.- � l � � ��� �� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal S <br /> Water Supply <br /> �New Construction � Single Family with ❑ Residence�---� <br /> Addition attached garage �Garag '�Accessory Bldg. �` ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck �_� <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 2,��� � <br />