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� � ' CITY OF ORONQ <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �-'�J O �\, Marling Address: Permit number. �i'/7� l <br /> ' � � �, PO Box 66 <br /> i O ��.� Crystal Bay, MN 55323-0066 Date received: - � -� <br /> ! i <br /> � ___ _Received by: _---..._�_._ ry <br /> � „ ,, 1 Street Address:� - <br /> �,� �� 2750 Kelley Parkway Plan review fee: � . �� �� <br /> �ly�.�sH���ti j Orono, MN 55356 ` � � .- <br /> _,�_ Main: 952-249-4600 Total Fee: / � <br /> Fax: 952-249-4616 wvvvuv.ci,orc�na.m��.us � ��� - - , .,� <br /> This application form must be completed in ful! and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) ��� y �; � i_,� � <br /> GENERAL INFORMATION: (� <br /> Job Site Address: �-�Q J fj �a� I �G' ��C���V�A � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f yes,a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficrent on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �V2 �� �7 � <br /> State License# 13C �7//y b Z Expiration Date: <br /> Phone: (cell) 95�. 52`l � �3o�i (office) <br /> Mailing Address: �7 Z� C� i2r� 3�, City:�'V�w Gz�^rncT►�� ZIP: $S 3� 7 <br /> Contact Person: � ,'� K Appiicant is: on / H meowner (Circle One) <br /> Email and/or Fax: �'�;� p��{ ��.c�v�c+ � � ���^^ _ <br /> �-, <br /> PROPERTY OWNER INFORMATION: <br /> Name: l�jfl fj NccCi l�i � q <br /> Phone (day): 4���' ��l� I � <br /> Address: �.- !'c[2 �a� 33�7 City: � 0�,��� _ ZIP: .j�j 3�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <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 ❑Accessory Bidg./Garage <br /> ❑Addi!ion � 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 ❑ Cornmercial ❑ 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 /> wvvw rninnehahacr�ek.or <br /> Estimated Construction Valuation (excluding land) $ /�, (D �� <br /> Last Updated: January 2016 <br />