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CITY OF ORONO j�
<br /> BUILDING PERMIT APPLICATION �° ��
<br /> �
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> ��O A'\ Mailing Address: Permit number: a0 I�J - D D 8 Z L
<br /> �V PO Box 66
<br /> , Crystal Bay, MN 55323-0066 Date received: �'Zl- �
<br /> ,
<br /> J, � ,], � ��
<br /> StreefAddress:' Received by:
<br /> � � ` V � 2750 Kelley Parkway Plan review fee: aD( �D6g7 �
<br /> t � `-' I�� Orono, MN 55356 � 33�,33
<br /> �kf5H0 L
<br /> Totai Fee:
<br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �d Q.J�.
<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: j 3 �,C� /��...�-v� f(-r nn D,r�v�
<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 su�cient on-site parking is availab/e. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION: �
<br /> Name: y� �2_��u J u 1-�n s�,. � -��►�L Ei c�►�.b4.�
<br /> State License# Expiration Date:
<br /> Phone: (cell) �I � �1'� �'���.� (office) y�� y`�-�- 3 �3 "�-�1
<br /> MailingAddress: �o �vr rf Cit : �K�,-Lo ZIP: .:���3L
<br /> Contact Person: ���,,.a� �c,V�.n ss,�, Applicant is: Contractor / 011l@OWfI@f (Circle One)
<br /> Email and/or Fax: �Q_�d�,, ; t�r��;',,.�--rscrC+�,�.,;►s�c. c7o+�
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: �L�..��4,, J�h��d,r. �C �� w� Gct►.Kb..�,.,�_
<br /> Phone (day): �,1�.- } ���'�,�
<br /> Address _ 1 3 �c� � rt�, i�rw. �r;� CitY: 'L`���p,.�� ZIP: �� 3��- �j }��
<br /> Email and/or Fax _�d�.����, !, Cv p-�„ --�r,E��,�-=�;',,�� •Cz�.,,�
<br /> ARCHITECT/ENGtNEER INFORMATION:
<br /> Name: M;k� T.��1�v� -' ��1�r ��s��...1 �r�C ,
<br /> Phone(daY)� q S a- - ��f(o - ��v-�
<br /> Address: _°�a N �t � w a ao � s�- c�ty: Jc�4,-� ZIP: `5�3 �a
<br /> Email and/or Fax: �w, .Lc�b �3 !,,�ti� d�f-t-;'��: G��.d c��i z�-. c o s�-,
<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 �C 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(specify)
<br /> MCWD review&peRnits. ❑ Industrial (� Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify)
<br /> 18202 Minnetonka Blvd
<br /> Deephaven,MN 55391 c
<br /> Phone: 952-471-0590 ��`� '� �� ��°�"ti
<br /> Fax: 952-471-0682 -�;, .»c,'s f•k-J I.v,we. .
<br /> www.minnehahacreek.or
<br /> Estimated Construction Vafuation (excluding land) $ 3S, oc=r% ``.'_
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