Laserfiche WebLink
- � CITY OF ORONO � <br /> � ��3� <br /> BUILDING PERM T APPLICATION � ��� <br /> FOR NEW STRUCTURES OR ADDITIONS ('� <br /> �O� Mailing Address: � d Permit number: oZ d�3-ob g 3 <br /> O PO Box 66 <br /> Crystal Bay;MN 55323-00 J� Date received: -7i(-'� <br /> aC. <br /> StreetAddress:' � Received by: (�.S <br /> y � 2750 Kelley Park ay �'� Plan review fee: 33�.33 <br /> F G <br /> �qkEsxo�`�` Orono, MN 55356 �� n?O/3 0083d <br /> Total Fee: � <br /> Main: 952-249-4600 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: °1-GOS � Ly��,,,.,Q G+��2� Ura�.o /�i.-. 53 3.3 I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approva/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/APP C}°►NT INFORMATION: � <br /> Name: �v 1,...-� /LtL.�.w- .-� � , <br /> State License# �G �3 y 9 i� Expiration Date: 3 3 ' <br /> Phone: cell 1-� -26 G/ office 6l Z -C8 '-2.LG � <br /> Mailing Address: Z Cit : r../ ZIP: cS c��3 q 1 <br /> Contact Person: o !^/,� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax. i o �� �LJ�'��o �s-fr•,���� ��, � . �� <br /> �phh Y`��I. C��.1C�hli�'1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �n.,._+,.-;� La✓�.r�L <br /> Phone(day): Q�Z=y 7 / �/L�t � .� <br /> Address: 2,CpSA_ l...�, G,,`y�.(,� City: v/��v-e ZIP: cSZS �3� j <br /> Email and/or Fax � <br /> ARCHITECT/ENGINEER INFORMATI N: <br /> Name: .1�1�.�. ���Z..G�'— <br /> Phone (day): /1- '-Z.6C 1 <br /> Address: /�03 Z /as��f /o� City: t.,./i•.,,y..�- ZIP:��.. <br /> Email and/or Fax: �� <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> �Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(spe ify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe_ _r: (Sp�Cify) , <br /> 18202 Minnetonka Blvd r'vc,vr•v� 4'sr��� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �S l�l�D.� <br /> _ � <br /> iFi <br /> . � <br />