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RECEi'vCD
<br /> .
<br /> CITY OF OR�NO JUL � 8 2015
<br /> BUILDING PERMIT APPLICATION
<br /> FOR NEW STRUCTURES t�R ADDITIONS C�N OF ORONO
<br /> �1 /�� Mailing Address: _�
<br /> �`'�" yO PO Box 66 Permit number:
<br /> Crystal Bay,MN 55323-0066 Date received: � •
<br /> � ,. Street Address:'
<br /> Received b : (�
<br /> G; 2750 Keiley Parkway Plan review fee: , 2
<br /> �l�kESH��� Orono, MN 55356 ���S�C����
<br /> Main: 952-249-4600 Total Fee:
<br /> Fax: 952-249�616 v,v�nv.ci.orono.mn.us
<br /> This application farm must be completed in#ull and aii required information must be submitted.
<br /> Incomplete appiicatioas will be returned. (Please print)
<br /> GENERAL INFORMATION:
<br /> Job Site Add�ess: / p jC ;� ,
<br /> Will #his be a Parade of Homes, Remodelers Show se Home or other Display Home? ❑ Yes No
<br /> If yes, a specia!event permit is required with Police Department and City Counci!approva/60 days prior fo the event Shuttle bus service wi11 be
<br /> required unless applicant demonsfrates su�5cient on-sife parlcing is available. Non pem►itted evenis will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> N a me: t��►��ti 4.t���c f_.i v�l�.,•, �-�<�
<br /> State License# Expiration Date: �
<br /> Phone: cell iZ_ �� _ � -- office G,SI- �ib- � 1383
<br /> Mailing Address: aZ� Q►�v�,��,�.,�- �, „Q,�� City �;�f ..! ZIp��;r.r'�j
<br /> Contac#Person: j�7;x� ���,,,�_ Applicant is: Contractor / Homeowner �Circle One) ^
<br /> Email and/or Fax: n� ; Ke��-'�Iy.�,r%�cs�p�� r .�h/i�►,if�Cfns rr�-c'�•+-,
<br /> PROPERTY OWNER INFORMATI�N:
<br /> tvame: t�-�•�y�<, �,lp•�-,e,S
<br /> Phone(daY): ��?-_�'S'i-�� �.�ti 4�
<br /> Address: �l� Z p/� ..� ��L:�Jk / ����..��. y CitY� �a-r�/�r�, V�//��1P: 5..�5'2?
<br /> Email and/or Fax �.�1,��, (� c��'��F�lL^"���rNrt""�S _��--�,
<br /> ARCHtTECT/ENGINEER INFORMATION:
<br /> Name: C�'�� er-'�N r►�► _ S'c��„�,.-,��s.t�,� F.�, �i��e� r-.�
<br /> Phone(day): (�'i- •7��_ ����p
<br /> Address: �1�� �'�..n �� ,,. t.v�<, y CitV: �I�j,fv r,«f, ZIP� _.5,..3//S
<br /> Email andlor Fax: „`,+�� :�,,,, ,,,,,,,� (� �,�,�;� �j�.,,
<br /> PROJECT INFORMATION: Descri tion of pro�ect: f��� � w�-� � / /
<br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & �
<br /> �New Construc#ion in le Famil with Water Supply �
<br /> (�'�� g y ❑Aocessory Bldg./Garage
<br /> ❑Addition attached garage ❑Deck
<br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer
<br /> g y ❑OfficelCommercial
<br /> ❑ Relocation detached garage ❑ Residence
<br /> ❑ Other.(specify) ❑ Multiple Family/Condo [j'Retaining Wall(s) ��rivate Sewer
<br /> ❑ Public 4feei or greater ❑ Public Water
<br /> *"Any earth movement may also require ❑ Commercial ❑Storage
<br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse
<br /> Minnehaha Creek Watershed Distnct(MCWD) �pther. s ea ❑ Private Well
<br /> ( p fy) ❑Other{specify)
<br /> 15320 Minnetonka Blvd
<br /> Minnetonka,MN 55345
<br /> Phone: 952-4�1-0590
<br /> Fax: 952-471-0682
<br /> v✓ww.minnehahacreeic.orc
<br /> Estimated Construction Valuation {excluding land) $ � I„��d��, �sU
<br /> Last Updated: January 2015
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