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1 <br /> ` � � � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number. ���O '-� <br /> j�� ���� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 5! `� � <br /> ' -�-- — , <br /> �� ,, StreetAddress:� ) �,, Received by: <�o—�C' <br /> \�' : 2750 Kelle Parkwa � <br /> F � y y � �{� �-y �` Planreviewfee: � 0�• �� <br /> `�'�f S H��� Orono, MN 55356 . / �� <br /> Main: 952-249-4600 Total Fee: ����+' � � I�l�' <br /> Fax: 952-249-4616 www.ci.orono.mn.us ��w� �� <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 f�L,r� L �,�,� r c. �l{'t �-t._ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 3� 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-sife parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �; �'�� f�ti^ -}-� <br /> State License# �����,3 ���) Expiration Date: �,3--Z ,��`� <br /> Phone: cell ' 'Z - 2 - --CGa2,. office <br /> Mailing Address: �" c, N, ' R,;,,,�.� 2� , Cit :(� � L..��--�e ZIP: � S�3 � <br /> Contact Person: �i '�,�,.,L /�J�� r.4...1,� Applicant is: Contrac or / Homeowner (Circle One) <br /> Email and/or Fax: p�����_ /��-�-�1-� �G �r c:,�ch� r�;;sM <br /> PROPERTY OWNE INFO�IVlAT14Ni��u+�t <br /> V�n�r��- <br /> Name: L>;� � �- � � � r � <br /> Phone(day): S � � c , � <br /> ` r---� <br /> Address: J��-(5 U��C,,S o� 12("� City: �►'Z(�/� ZIP: _5 S �S� <br /> Email and/or Fax e��� c�c,, lv�:n�i�z� ��, �,rc� - c" ��� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /�,lv/UC._ <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: ��'' ''� � �-��b"1 S j . �,�,� <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 J�"Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation - detached garage ❑ Residence ❑ Private Sewer <br /> ['Other. (specify) c'.��� �'-�'(k�si�a^ ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Pub,lic 4-feet or greater ❑ Public Water <br /> **Any earth mo ement may a so 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) � /j� L�C�C� <br /> � <br />