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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: � (,,''f �O� �� U� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � — �—�(O <br /> Street Address:' ��� <br /> y�, G� 2750 Kelley Par a � ��'� Plan review fee: • L <br /> �yk�SHo��. Orono, MN 5535 ��u,� ,�� c� <br /> Main: 952-249-4600 <br /> Fax: 952-249-4616 www.ci.orono.mn.us � �� � 'f�r <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) L�,S T /ol��/� <br /> GENERAL INFORMATION: <br /> Job Site Address: 31�1 S Nor�-1� Sl�or� ,pr-, <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 Counci/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: go er 6u�.►1d�� C'cy� . <br /> State License# (�C �S L9 g8 Expiration Date: /, <br /> Phone: (cell) 61 Z-814 - Z2.oo (office) 9 S 2. ' y�S ' 2oq?' <br /> Mailing Address: 3�135 Ct !�1 City: yvl�['KfF ZIP: SS SfS <br /> Contact Person: Sec F'ro�,nsen Applicant is: ontract / Homeowner (CircleOne) <br /> Email and/or Fax: �oQ., �ro.nsw•. C� doye�tw►ildinq. Com <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Pe.t�- R. �� <br /> Phone (day): tZ- 3cg- �q�y <br /> Address: �°�b$S �xttlsio� (31� , City: �x�e�sior' ZIP: ,s,s33/ <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: - • ( � <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 /> �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 />