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i <br /> CITY OF ORONO � , �� <br /> 9,� �� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O♦ , � �) Mailing Address: Permit number: � � � '�i(�`�t � <br /> t�� ��Box 66 <br /> O �,}'� \,� ��Crystal Bay, MN 55323-0066 Date received: �- - Z�` � <br /> � �(`�y r), �� 1 � Street Address:� /_� - -��� �eived by: � <br /> y�, G� U` \.� 2750 Kelley Parkway ( ; :��' 7"�� �� �n reyiew_fee: J • 5�' �� � �-. <br /> � <br /> �7'�kSH�4� 'Nlti�� �1 Orono, MN 55356 �= _.—___ -----��{��- - - _ - - - <br /> � � �' Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <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: <br /> Job Site Address: ��o, t3�.N•5 �pa�-c �2�..Z <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 approva/60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 4Ync��� � Lt-c <br /> State License# 1"j�.SqN 3 i 5 Expiration Date: 3- �5- � S� <br /> Phone: (cell) �It- 2�"►- 26"►� (office) G►2- H�z- yeoo <br /> MailingAddress: �53 L.�� S-C cUs-�' Cit : w• �a�y ZIP: Ss3q1 <br /> Contact Person: Svc•� (�„�,Sf�s.,a A plicant is: rac o / Homeowner (Circle One) <br /> Email and/or Fax: d�►a �.��,,,�.1, c Q <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Q�r�r � ,M,�t►Ss� 5•...-w.�►- <br /> Phone(day): (�y�- 3�3- 3��fl � <br /> Address: iz�5 Nw S I. .� Cit : ZIP: SSyy <br /> Email and/or Fax_.._. D S(�✓1 O�S , .(l3►� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � �ths� N (r�w <br /> Phone(day): qSz- �I�3- ��� <br /> Address: �{c� ►.��-� 4-t f»sT City: ��ys,r.. ZIP: SS3ti i <br /> Email and/or Fax: �C„-�.,���, a, plt,r.��r�tst•..� ����. ��..�. <br /> PROJECT INFORMATION: Descri tion of ro�ect: ! �% E'= �-�-' ' f �-r�'''��-- <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <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 ❑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 ❑Commercial ❑ 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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ /,SSo,�ao <br /> � <br /> Last Updated: January 2016 <br />