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, CITY OF ORONO //, �..� <br /> � <br /> �Z <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,O MailiPO Bo�r66 � Permit number. Z�L -�j�— ' � <br /> �V � <br /> Crystal Bay, MN 55323-0066 Date received: —7 <br /> y � , �•� Streef Address:� ���� �� � � <br /> �, � 2750 Kelley Parkway �� � lan review fee: . �g <br /> l9kESH�4�G �G Orono, MN 55356 ��(5 <br /> Main: 952-249-4600 Total Fee: � <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> �::��,,�,t - ���.�y�j�- <br /> This application form must be completed in full and all required information must be s mitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: � � S S ;� , ����/1�1 ��Z. <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. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non permitted events will not be allowed. <br /> CONTRACTOR/AP�ICANT INFORMATION: <br /> Name: -"rylJ) J�<���'z-v�n �--�rv����6� /z= � <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: C r1�� l�� �"�r��,,,.� <br /> Phone (daY)� G�� Z- Z�;� 9 Yu;; <br /> Address: ���, 1 y�:�►�-12� �_,,,.� �� . City: ()�'v,r�;�; ZIP: S5 _jf�`-� <br /> Email and/or Fax �,�,,� �, �_-;.-r,��,�. � �r�-�_ 4;,,,� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: `� ! -�/'�„�.� <br /> 1'�'� �, �-'� � � <br /> Phone (day): � � <br /> Address: <br /> � <br /> Email and/or Fax: � O , � g <br /> � / � <br /> PROJECT INFORMATION: Description of project: � � , �. <br /> 1.Type of Project 2. Proposed Use �� �osal 8� <br /> . � iy <br /> �lew Construction ❑ Single Family with ' <br /> ❑Addition attached garage � �� <br /> ❑Accessory Building ❑ Single Family with �,,p , <br /> ❑ Relocation detached garage � ��`� <br /> ❑ Other:(specify) ❑ Multiple Family/Condc �-� ' <br /> ❑ Public ���� ^ ,�n <br /> "'Any earth movement may also require ❑ Commercial � ,�''1,d �� ` <br /> MCWD review&permits. ❑ Industriat <br /> Minnehaha Creek Watershed District(MCWD) ❑ 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) $ �� Z�, �� <br /> Last Updated: January 2015 <br />