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� � . <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> q,. Mailing Address: � —� � <br /> / �'O'vO� PO Box 66 Permit number: <br /> �/ �. Crystal Bay, MN 55323-0066 Date received: <br /> 1 ' _ <br /> � a �� StreetAddress:' Receiyed bv: ___ �� <br /> --- <br /> y,� G: 2750 Kelley Parkway _ Plan review fee: � ('� . � � <br /> rqkf5������ Orono, MN 55356 � � �� _��� <br /> `��= Main: 952-249-4600 � <br /> 7otal Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us �7 /�, <br /> �� � �- . . <br /> This application form must be completed in full and all required information must be sub itted. <br /> Incomplete applications will be returned. (P/ease print) f,�`�����1� SJ�J�� <br /> GENERAL INFORMATION: <br /> JobSiteAddress: ,_,�(,,as /I•lp��� v��v�� �R��� � <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 approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,v�iR �v .Q l.v <br /> State License# �Q���T Expiration Date: <br /> Phone: (cell) �,2 -3a S-1�$59 (office) . ��2_ �y_ 36 yg <br /> Mailing Address: yq�p ,�;,,,�al�. R�'ve., City� '�/,,,,,a ZIP� $�y�6 <br /> Contact Persorr. 7,�,.,., Applicant is: r o�?/ Homeowner (CircleOne) <br /> Email and/or Fax: f,'M W a�v�.�e o.v Ro a c c�a <br /> PROPERTY OWNER INFORMATION: <br /> Name: /`}n,e�2+ �s�,le�/ /��e�r�o�{ <br /> Phone (day): <br /> Address: _026�� Na2t Stio�ee Aar�✓�2. Cit � D�v�o ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit � ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> (�Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with � Public Sewer <br /> 9 y ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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 �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 /> $ / c� <br /> Estimated Construction Valuation (excluding land) � �Q�O RECEIV I� <br /> MAY U� 2017 <br /> Last Updated:.January 2016 <br /> CITY OF ORONO <br />