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r , <br /> - CITY OF ORONO <br /> BUILDING PERMIT APPLICATION l� a8g �� <br /> l <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> .�O A,O Mailing Address: Permit number: ��� '�O COO <br /> �V PO Box 66 — <br /> _ � Crystal Bay,MN 55323-0066 Date received: lP'J�'� 7 <br /> a � <br /> StreetAddress:' Received by: T-'� <br /> y G� 2750 Kelley Parkway Plan review fee: � �. � <br /> � <br /> ��KFSHo��. ��1 Orono,MN 55356 a� ��_� � � � <br /> n�rr�,{�� Main: 952-249-4600 Total Fee: <br /> 1; <br /> �"�' Fax: 952-249-4616 www.ci.orono.mn.us <br /> This applica�on form must be completed in full and all required information must be submitted. <br /> Incomplete applications wfll be returned. (Piease prinf) <br /> GENERAL INFORMATION: � <br /> Job Site Address: '�d t 1 �r6�� S�.Cs/+-p_ �(�-�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes �No <br /> ff yes,a special event permit is requJred with Police Department and City Council approval 60 days prior to the evenf. Shuttle bus sen�ice w�1/be <br /> required unless applicant demonstrates suRcient on-site parking is avai/able. Non-permilted events will not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATION: <br /> Name: �i,J ,J � n�c� <br /> State License# (�` ,�7 �;�Z Expiration Date: 3 1 F( <br /> Phone: celi �� � • " 3 office - 7$ •- �zd <br /> Mailing Address: ,v� (Lo Cit : ,�, ZIP: CJ <br /> Contact Person: 1 z,. ,�,, ,J Applicant is: ontra / Homeowner �cnae o�.> <br /> Email and/or Fax: �'_u2T' v `'x�sh-.�5v��J►^�-S - �� <br /> PROPERTY OWNER INF�ATION: <br /> Name: f���S ��J•� <br /> Phone(day): / - p$ D�,�,�2c� <br /> Address: . Cit : , / ZIP: <br /> Email and/or Fax L , d <br /> ARCHITECT/ENGINEER NFORMATION: <br /> Name: <br /> Phone(day): - ` -� 06 <br /> Address: c I-I-,..tc� @ Cit : �j ��vt. ZIP: <br /> Email and/or Fax: GGt..�) s� (,�F� Scc,..i � C'�l�'t <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> New Construction �Single Family with ❑Accessory Bldg./Garage <br /> dditlon attached garage ❑Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑Relocation detached garage ❑Residence ❑Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Retaining Wall(s) <br /> ❑Public 4-feet or greater ❑Public Water <br /> "My earth movement may also require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed Distriet(MCWD) ❑Other:(speCify) ❑Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> . in ha r .o <br /> Estimated Construction Valuation(excluding land) ; �2 7� c�c� <br /> Last Updated: January 2016 <br /> RECEiW��'! <br /> �u� 0�?0�7 <br /> CITY OF ORONO <br />