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- . <br /> �� CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: " l �O�D I O� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � �-- �—�� <br /> Street Address:� /� <br /> � G� 2750 Kelley Par �a �K'� Plan review fee: <br /> ��q'�FSHo4� Orono, MN 5535 Cj��,1 '�� C� <br /> Main: 952-249-4600 <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in fuil and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 31�1 S Nor�4-�, Sl�or� .�r-. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [g No <br /> If yes,a special event permit is required with Police Department and City Council approva160 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: [�jo er (3k.►1d� Cay� . <br /> State License# (;C �S L9�8 Expiration Date: ( f <br /> Phone: (cell) 61t-S1R - 2.2.00 (office) 9SZ ' 4�1 S ' 209? <br /> Mailing Address: 3`�3S C� (O� Cit : y►1TKfF ZIP: SS yS <br /> Contact Person: e� F'�-o�nso� Applicant is: ontract / Homeowner (CircleOne) <br /> Email and/or Fax: �oe, ��Anse,�, Q boye�-bu►ildi�q. Com <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: P�t�- R. �r- <br /> Phone (day): IZ.,- 3og- Iq7�{ <br /> Address: I�1bgS Ex�elsio� (31� . City: �x�e(siar' ziP: $S33/ <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: - 1 -TC� <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 ❑ 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 /> '*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.orq <br /> Estimated Construction Valuation (excluding land) $ .350 000 <br /> Last Updated: January 2016 <br />