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�.- <br /> CITY OF ORONO ��� �0�� <br /> BUILDING PERMIT APPLICATION lpV�► <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS � <br /> O Mailing Address: � ✓1 Permit number: ' G l � � L�C' )i <br /> I <br /> � �� Crystal Bay,MN 55323-0066 'l,�`�` Date received: � �- � L � �� <br /> StreetAddress:' Received by: ' -Zn <br /> y�, G� 2750 Kelley Parkway,L `��'�—L(.,�(1�.'r'�� PIC Crevie3 f)7��_ �_� �___� ..,__�.3 <br /> � �, Orono,MN 55356 <br /> �k'ESHO� Main: 952-249-4600 Total Fee: � <br /> FaX: 952-249-4616 �n�ww.ci.orono.mn.us '',.,,�, ��,` ' � <br /> This applicaiion form must be completed in full arrd all r�qair�et�information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��, 7 L�lc.���e.�! .�.l��,.,� �,, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe ispiay Home? Yes o <br /> I/yes,a spec/al event peimlt is requirsd with Police Departmenl and Clty Councll approva160 days prior to the event. Shulfle bus service wlll be <br /> required unless applicent demonstrates suRcrent on-sile parking is availabfe. Non-perm/ffed events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: u'�t�5� <br /> State License# G G L�►!�� Z Expiration Date: / <br /> Phone: cell (o, • •—� office l� • �F7� •o Lo <br /> MafHng Address: ,x.L! z Cit : ����.u� ZIP: S3�f U <br /> Contact Person: u � �o N Applicant is: ontractor / Homeowner (ci.oi.o�o� <br /> Email and/or Fax: G„..� ��„�x�� I�,�, ova5 �c�M <br /> PROPERTY OWNER INFORMATION: ' <br /> Name: La�it-,�s k �K9 �!w►�dit �-S tt.1 <br /> Phone(day): 7l0 3 `�Z 3 - BL�`j <br /> Address: /!'�p 8 ��r4 /�� � City: /'��/µ-v��^ ZIP: S�`f�� <br /> Email and/or Fax �r� 2..�.• '�� C �L • � <br /> ARCHITECT/ENGIN g,INFO MATION: _ <br /> Name: �f P ��rr1,•i,.er, � 11�-5�c r-' � ��l� <br /> Phone(day): ?� 3. ? c <br /> Address: Cit : ZIP: <br /> Email and/or Fax: G , �I�cu1� ✓ ��*,P���S c.J ��+/` <br /> ��- <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of ProJect 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ]�New Construction �Single Family with ❑Accessory Bldg.!Garage <br /> Addition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑OfficelCommercfai <br /> ❑RelocaGon detached garage Residence �Private Sewer <br /> ❑Other:(speciy) ❑Multiple Family/Condo �Retaining Wall(s) <br /> ❑Pubiic 4-feet or greater ❑Public Water <br /> "`Any earth movement may also require ❑Commercial ❑Storage <br /> MCWD revfew&permits. ❑Industriai ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef:(SpeC'rfy) ❑Other(speCify) <br /> 15320 Minnetonka Bivd <br /> Mlnnetonke,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax. 952�71-0682 <br /> www.m fnnehehacreek.o <br /> Estimated Construction Valuation(excluding land) $ �0 �J <br /> Last Updated: January 2016 <br />