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�) RECEivc�
<br /> CITY OF ORONO � ���,L�a�' JUL 28
<br /> ' BUILDING PERMIT APPLICATION �'�� 2015
<br /> � FOR NEW STRUCTURES OR ADDITIONS CITY OF oRONo
<br /> O�j Mailing Address: Permit number: � -�9
<br /> � 'wO PO Box 66
<br /> Crystal Bay,MN 55323-0066 Date rec:eived: � '�'�
<br /> � ,, Sfneet Address:'
<br /> Received b : �...
<br /> y G; 2750 Kelley Parkway Plan review fee: , 2
<br /> ���k�sHv��' Orono,MN 55356 070�5�(��q�
<br /> Main: 952-249�600 Total Fee:
<br /> Fax: 952-249-4616 www.ci.orono.mn,us �(,� f j{,� �p '�t5'�(�
<br /> T���P���a�oi��� .: ` ��
<br /> !� ",�� , ;�� � ... .ti��� . �. ... �, (Please print) .. .�,
<br /> GENERAL INFORMATION:
<br /> Job Site Address: / p � �
<br /> Will this be a Parade of Homes, Remodelers Show se Home or other Display ome? Yes No
<br /> If yes,a specia!event permit is requined witi►Po�ce Deparbnenf and City Council approval 60 days prior to the evenL Shulile bus�rvice will be
<br /> required unless applicant demonstrates suffkient on-site parkir►g is availa6le. Non-pemritted events wil!not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: %�,n� �.� r (�r�i»� :��d
<br /> State License# Expiration Date':
<br /> Phone: cel! 1 - - 1 office /- Zib-Z 88
<br /> Mailing Address: 3z� Qrv��w� v �4✓+� Citv 5�,;�+f k1 ZIP�,��j
<br /> Contact Person: �j;�e �����; Applicant is: Contractor / Homeowner �c�.�e o�>
<br /> Email and/or Fax: ,y,; �cP,(�ly..� �.�c u r�/;�,i��d ns.�.c'�M-+
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: �r�'�`le�: �f-�+e.S
<br /> Phone(daY): (vL2- �yi- 9a�� � F�ti 4✓�
<br /> Address: l�/�a z e/ ���p.-r�wlk / ���......�, y CitY- %/r•, �!�//��IP: SSy�2
<br /> Email and/or Fax t�.�l,a., (����n�/P6,r'D�L!s'r.�tit'S .r v-•,
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Name: C�,-F e„-',+��_ Sc�+i»�+�►v-�s�.' F.� �i�pr�rS
<br /> Phone(daY)� laSi-?�7y'- ��j(�O
<br /> Address: 1l0/ �,s,,,,� �� ,r I.v� y City: �j��i�v••-•«,/; ZIP: .SS//.,,�'�
<br /> Email and/or Fax: C,,;+P,,:„,,., s,,,,,� ('���,...,�il-��-���
<br /> PROJECT INFORMATION: Descri tion of ro'ect: f�:�G�/ � W�� � T /
<br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disp�ai 8�
<br /> Wa�er Supply
<br /> �New Construction ("�'Single Family with ❑Accessory BIdg./Garage
<br /> ❑Addition attached garage ❑Deck ❑ Public Sewer
<br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial
<br /> ❑ Relocatia� detached garage ❑Residence �rivate Sewer
<br /> ❑ Other.(speafy) ❑Multiple Family!Condo �Refaining Wall(s)
<br /> ❑Public 4feet or greater ❑ Public Water
<br /> *"Any earth movement may also require ❑Commercial ❑Starage
<br /> MCWD review S permits. ❑ Industrial ❑Warehouse ❑Private Well
<br /> Minnehaha Creek Watershed District(MCWD) �Qther:(speciTy) ❑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 Constnaction Valuation{excluding land) $ �,p��, vG�
<br /> Lasf Updated: January 2015
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