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I �' <br /> �' � � � <br /> � <br />� ' CI�Y OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: �l(p-l� �� <br /> � f VO PO Box 66 <br /> Crystal Bay, MN 55323 00 Date received: '�D " �� <br /> a � <br /> Street Address:� ` Received by: <br /> y�, G� 2750 Kelley Parkway Plan review <br /> lqKfSH��� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: a�/„� g g <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: 2(�9� ►�;�1 �4ve aCr,�W ,�,�r� 5� 5 i r <br /> Wili 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/APPLICANT INFORMATION: <br /> Name: �tco��,.x.��� LL�� <br /> State License# �C,bs�CZ� Expiration Date: <br /> Phone: (cell) �52-- �,��-�I"L9 t�u 1 - l� I Z (office) E�L-r�G� -�cc�: <br /> Mailing Address: �c�3 L.�.k� S{ ���St City:y�,���� ZIP: r53�t <br /> Contact Person: RI�X � �a ng Applicant is: Ce�acte� / Homeowner (Circle One) <br /> Email and/or Fax: �,lex� �{-�;��wcr�..c�,�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �1�:ci: r.r�� �'o� I'��2f <br /> Phone (day): NrA <br /> Address: Z��s I�,t�y Av�c �'�4�� ;,M4J 553 31 City: OC�,�v zIP: 55331 <br /> Email and/or Fax ��A <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 ro�ect: �C�' �ic �s <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> 4New Construction 0.Single Family with ❑Accessory Bldg./Garage <br /> �y Addition attached garage � Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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) $ S�6(� <br /> Last Updated: January 2016 <br />