Laserfiche WebLink
' � 1 CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O ` _^ Mailing Address: Permit number. `7 � l �a •-(.���Z- <br /> 1V PO Box 66 - <br /> ti-� Crystal Bay, MN 55323-0066 Date received: �]"' � �—��v <br /> StreetAddress:' Received by: " <br /> yF � 2750 Kelley Park ay� L �(O —UC��'S� Plan review fee: � �g.3. Z�� <br /> t �' Orono, MN 5535� � � <br /> �KfSHO�`c. -_ � w�-�(-�.. ______.._ ___ <br /> Total Fee:L � � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �Z <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: �—VYZS9 �ll�I�b <br /> Job Site Address: �,5 (;c�/L�VIG(� Cct/)-�'" <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a specia!event permit is required with Police Department and City Council approva160 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: fUOr'�1 H�oM�Gs� LGC, <br /> State License# L3GG39 aa-/ Expiration Date: ,j-,�I'�7 <br /> Phone: cell /1� b- office 7 G3-.�59-�?1 <br /> Mailing Address: S� �, N. s�-.�. Ci � dv ZIP: S" � <br /> Contact Person: i5 No� Applicant is: ontracto / Homeowner (CircleOne) <br /> Email and/or Fax: Ch ' •C �1v3•$S — <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,SOUrce ��,� ��{dprne� <br /> Phone (day): �(p�. $ l� !�/OI'j <br /> Address: ( �+ , N .d Cit : � I�l ZIP: SSYY� <br /> Email and/or Fax �J, <br /> ARCHITECT/ ENGINE�R INFORMATIO : SUfVI�Qf: CY�19•YYIOR�.. �1 Wfb �2J•Cpl'VI <br /> Name: G{,l'I1�1 /�GIII�°� �YG�?r7C�iiN� ,`�lgl--� <br /> Phone (day): (�(Z-g?0 • �38"g <br /> Address: OSO � N Cit : � !I?D�!-�'l�, ZIP: ,s,S <br /> Email and/or Fax: 101�r!'i e5/►ZG/►ta.Q� I C�dv . C or� <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> �New Construction [�Single Family with �esidence <br /> Addition attached garage Garage/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&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) $ ��� ���,��C" <br />