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. <br /> � <br /> ,� CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O ♦ _O Mailing Address: Permit number: Z D�L� 'bv�-I��- <br /> 1�� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: `LZ <br /> Street Address:� �y� 2, � � <br /> y � 2750 Kelley Parkw .- l/� � ( ✓ Plan review fee: <br /> �t�kESH�4�G Orono, MN 55356 �"Q)� �- � C� <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: f $3 o S't��L,nF R,v� <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 Ciry Council approval 60 days prior to ihe event. Shutt/e 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: ��v,u�,o�c� � L�� <br /> State License# �L�q 9-3�� Expiration Date: <br /> Phone: cell IZ- b'� - Z6 u office i2- CZ- oq� <br /> MailingAddress: ��3 �,�T � -r• City: w�}-y�/�-i-fl ZIP: �3q � <br /> Contact Person: S y�,� G�s �Fs�•J Applic nt is: C r or / Homeowner (Cfrcle One) <br /> Email and/or Fax: Sy�,,� .� S�c �,oe . Cow.. ,�DI�-t��5�ev�cx��• �--�r� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �.45 h ,sR/� T�FAR� <br /> Phone (day): - - 'L <br /> Address: � 0 q �/� M�ss i ss,PP� l N City: cl��M PL��� ZIP: SS31 � <br /> Email and/or Fax ,tvF�A � ,�nefia-�TN. c�r� <br /> ARCHITECT/ENGINEER INFORMATION: • <br /> Name: ��,,.�„s �, �� �r� <br /> Phone (day): 5�1• 2�3•36 3� <br /> Address: l53 E• E Cit : V`�AK��+ Z�P: S 9 <br /> Email and/or Fax: �o� , s�o�e�,..a.�. «.�- <br /> PROJECT INFORMATION: Descri tion of ro�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 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 �r 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) � l, Sr] -�'j� �OC7 <br /> Last Updated: January 2016 <br />