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' CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �OA ,O Mailing Address: Permit number: (� " �'� (�.� <br /> ��� PO Box 66 .1 <br /> Crystal Bay, MN 55323-0066 Date received: �l� `7 <br /> StreetAddress:' eceived by: � <br /> y�, G� 2750 Kelley Parkway ��'� lan r �w fwe,e� �� <br /> t.qkFSNo��. 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: � �4� �SC o� -�• ��o�O,�'lN Cvs,35 lo <br /> Will 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 available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ' ���. � w�-Q_ ti� <br /> State License# 'g�c,�p3"\b Expiration Date: 'Zp <br /> Phone: (cell) �„\2`SS�-1 -2SSb (office) �S'Z="\�11- 3�lZp <br /> Mailing Address: Cit : �,o ZIP: � 'Z'� <br /> Contact Person: '��"'L.� Applicant is: ontrac or Homeowner (Circle One) <br /> Email and/�r Fax: '�Z p� ` . C..E�N..•., <br /> PROPERTY OW ER INFORMATION: <br /> Name: s`��`�- C1'.�-S��_�%t�v1G��� <br /> Phone (day): (0�2-�{�L{ "2��6�1 <br /> Address: � Cit : �,9v�pJ`, ZIP: �jS�j Lp <br /> Email and/or Fax ' @ <br /> ARCHITECT/ENGINEE INF RMATION: <br /> Name: <br /> Phone (day): — <br /> Address: Cit : ��Y�S ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ��4�`� �� `fO �(low�� . <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.orq <br /> Estimated Construction Valuation (excluding land) $ ���OOo . <br /> Last Updated: January 2016 <br />