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� , <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: � (� " -(�Q �� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� j `1 <br /> � � Street Address:� __.___! eceived by: � <br /> yF G� 2750 Kelley Parkway � �7 ��t� lan r �w�� �3 � <br /> `9kESN��� Orono, MN 55356 'D � ----- <br /> Main: 952-249-4600 Total Fee: �^ � � �'�✓' z--, <br /> Fax: 952-249-4616 www.ci.orono.mn.us ���lC� � <br /> This application form must be completed in full and all required information must be submitted. �l�s�, <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: J��JII� <br /> Job Site Address: ��l � �S�p�� . l�p�, ��p�p,�N 5535 lc <br /> Wiil this be a Parade of Homes, Remodelers Showcase Home or other Disp ay Home? ❑ Yes �'No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is avai/able. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ���� � w•�_ v� <br /> State License# 'g���p3"\� Expiration Date: 'Zp <br /> Phone: (cell (n\2`SS�-� 'ZSS b (office) �SZ='���.— "�"-'1�.._p <br /> Mailing Address: Cit : �,o ZIP: � Z'� <br /> Contact Person: '��'L Applicant is: ontrac or Homeowner �c��cie o�e� <br /> Email and/or Fax: '�-Z p�.,� ` . C..pµ.t, <br /> PROPERTY OW ER INFORMATION: <br /> N a m e: ` vt�- C_G�-S�C_�-�t.►�-+��� <br /> Phone (day): (0�'2,:L{�L{ �2�`6�l <br /> Address: y��� �-4���'g���, . City:'�1��,9v�pJL, ZIP: SS� LD� <br /> Email and/or Fax ���,,�. � ���@ ��9,�;�,`, ���_ <br /> ARCHITECT/ENGINEE INF RMATION: <br /> Name: <br /> Phone (day): — — <br /> Address: Cit :����l1.S ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: {��� �� `� �(l�v-^--�� - <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 8�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.orq <br /> Estimated Construction Valuation (excluding land) $ ������ ' <br /> Last Updated: January 2016 <br />