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• � <br /> � ' �. <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION % � ' �; �� <br /> , �,. <br /> FOR NEW STRUCTURES OR ADDITIONS '%' <br /> �O�O Mailing Address: � Permit number: � ;`��--� � "�',`-, <br /> � � PO Box 66 <br /> I Crystal Bay, MN 55323-0066 Date received: -� 1Cl— (S � <br /> C ��� StreetAddress:' � vj �� Received by: �'� <br /> � <br /> y�, G` 2750 Kelley Parkway Plan review feg: �- <br /> �qk�SH���, Orono, MN 55356 JS{ <br /> Main: 952-249-4600 Total Fee: ��� �5',/� �-l-"� <br /> Fax: 952-249-4616 www.ci.orono.mn.us 7`' <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) � �e � � NVe — <br /> GENERAL INFORMATION: �. i �, -, � NP " -�"- <br /> Job Site Address: ���� �(Ct1' • �,(� <br /> Will this be a Parade of Homes, Remo elers Showcase Home or other Display 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/A PLICANT INF RMATION: � <br /> Name: �;� �;(�, <br /> State License# � Expiration Date: <br /> Phone: cell - 5 �(�� (� office <br /> Mailing Address: ZS�15� i ✓ ��,�� Cit : ��Yo ZIP: 3j <br /> Contact Person: J v� � Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: ' <1c� " y a; , �DI/�. <br /> PROPERTY OWNE INFORMATION,: <br /> Name: (��v� U <br /> Phone (day): -��(� � � 5 r� � <br /> Address: � "�� L i' �� (,��r�;t� Cit : (,r�Ij/� • ZIP: S 5 �.� � <br /> Email and/or Fax i �� � � . � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: i! �i✓► I � ��� <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) �I � ❑ 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) $ V� �� <br /> Last Updated: January 2015 <br />