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" r � CITY OF ORONO `� ,3 � <br /> BUILDING PERMIT APPLICATION /� � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O A, Mailing Address: Permit number: ����0'�� � <br /> � `VO PO Box 66 _ <br /> Crystal Bay, MN 55323-0066 Date received: -��0 <br /> .� ,, Street Address:' <br /> Received by: <br /> y G� 2750 Kelley Parkway Plan review fee: �� <br /> F <br /> `qkf5H0��` Orono, MN 55356 S <br /> Main: 952-249-4600 Total Fee: �� � �� <br /> Fax: 952-249-4616 www.ci.orono.mn.us � yL��d _ <br /> This applicatian fortn must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: _��',sS ��✓I uxyl� d�l �rc�_ <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 wdh Police Department and City Council approval 60 days prior to the event Shuttle bus service will be <br /> required un/ess applicant demonstrates sufircient on-site parking is availa6le. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP�LICANT INFORMATION:. <br /> Name: �t.,�.. � 1 c 4�L l�U: I��--� �" L C.. <br /> State License# _ 1 3L 66 7`f 3 S Expiration Date: 3/c 7 <br /> Phone: cell '� -� c, -� 'L► office <br /> Mailing Address: "� �� �� • �,! ,:�c +�� Cit : �-�,Ci�„L ZIP: <br /> Contact Person: c r��., :-�h Applicant is: ontracto " / Homeowner �circ�o�e� <br /> Email and/or Fax: _�°'� u�,;:,r4,yr.�� �4'livtGi�� I, C u:� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> ►vame: Trit i>�� H�' I IS <br /> Phone(daY)� `( � - � -Z I �� - <br /> Address: � � y c� Cit : ��c� ZIP: � 3� <br /> Email and/or Fax +�^��,,,�, , � ,�I�s Z �� ��'r-t';� . CU�� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> - � ; � ���� <br /> PROJECT INFORMATION: Descri tion of ro�ect: ` X 1 ��. � <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal8 <br /> ❑ New Construction Water Supply <br /> ❑Single Family with ❑Accessory Bldg.I Garage <br /> ❑Addition attached garage �Deck <br /> ❑Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑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 <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: S eCi ❑ Private Well <br /> 15320 Minnetonka Blvd � P �� ❑ Other'(SpeGfy) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) � -��j�"=' R�CEIVED <br /> �t�R �4 Zp1� <br /> Last Updated: January 2016 y� <br /> Y�i����� <br />