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, ', .i <br /> CITY OF ORONO ' 0 z 1 s • <br /> �6/24i2�, <br /> �o- `'' . e�\ BUILDING PERMIT APPLICATfON <br /> � FOR NEW STRUCTURES OR ADDITIOIVS <br /> �- ....�. .._ :_�.. . <br /> �O�O Mailing Address.� Permit number. �� �i�(o — 7 <br /> PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: �-1> .�, - <br /> Streef Address:� Received by.�. <br /> ti�, G� 2750 Kelley Parkw 2 ���C'��2��� Plan review fee C'c r����d�� ��' <br /> T . � <br /> �'�KEsxo��` Orono, MN 55356 / ;� �k �: ��z� �c,- /�t��z,1 — ci� <br /> Main: 952-249-4600 Total Fee: �,^� �� ,r�� <br /> Fax: 952-249-4616 �vvfv�,.ci.orono.rnn.us `� '� <br /> This application form must be completed in fufl and all required information must be submitiea. <br /> Incomplete applications wilt be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: S � ' � 4;�• `,�, ��,�� ,{` � ,�-a N,�, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Home? ❑ Yes o <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 w�I be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIQN• � <br /> Name: � r�c�E. � � �.;�, <br /> State License# � �" Expiration Date: �,. � }� L <br /> Phone: cell - Z ' � �`i` office �-- <br /> Mailing Address: ( � " �'a � , �j Cit . •` ',�� �;; ;, IP: � <br /> Contact Person: ` yr•� Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: ���d���,� �,�����y��w �'�;v�y� � „� <br /> t> v <br /> PROPERTY OWNER INFORMATIO� � � <br /> Name: ' � �,� �kt <br /> Phone (day): � --�� <br /> Address: �, Cit : L�n ZIP: ��� � <br /> Email and/or Fax �. �,� �;�v�rr �,. � ' -�- � <br /> ARCHITECT/ENGINEER INFOR TION: <br /> � � . <br /> Name: �u i S� ' f ��� e�; ��'� �' �1 v.��'c' <br /> 7v. J � v <br /> Phone (day): ��: <br /> Address: � ' � � � Cit : ZIP: '"�'""_�� <br /> Email and/or Fax: � ; � ,� ,� �; - . ; <br /> • � Vl <br /> PROJECT INFORMATION: Description of project: � � � ' v� a..����►e �r� � `; u�l <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 /> �ccessory Building l.�c;��j '� ❑ Single Family with ❑ Office/Commercial <br /> [� Relocation detached garage ❑ Residence <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ 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 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well <br /> ( ) �Other. (specify) ❑ Other(speciry) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 ��� <br /> Phone: 952-471-0590 �� � e <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or �t�(;l � <br /> Estimated Construction Valuation (excluding land) $ �Z� �'� <br /> � <br /> Last Updated: January 2015 <br />