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, - CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number. Zj� (p — ��� � <br /> i VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � � ' <br /> � Street Address:' Received by: <br /> y�. G� 2750 Kelley Parkway ���-�b i� lan reviewfee: � , <br /> t�kESH��� Orono, MN 55356 e-tc. 5�9� <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: (p -x,� �� S , (�L 1�(�-- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �Alo <br /> liyes,a special event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events wil!not be allowed. <br /> CONTRACTOR/APP�ICANT INFORMATION: <br /> Name: �m�S 13� L��Cr�`{ <br /> State License# L- Z, Expiration Date: <br /> Phone: (cell) (p�2-- Z'"!p � l��-1 (office) (Qt Z - a•'t�- (�'�t� <br /> Mailing Address: � ^� Cit : e' ZIP: <br /> Contact Person: S��-( L--r�v���,,.� Applicant is: n rac / Homeowner �c�«ie o�e> <br /> Email and/or Fax: S�-fN � �crn�-'� f3�L���'t�cJ;�[��S . c o�. <br /> PROPERTY OWNER INFORMATION: <br /> Name: �o,S ��gSL�� <br /> Phone (day): �1'SZ- 2�u - '17 <br /> Address: 3(or�3 cn>r�e Sr e,¢.� -�r� �v� City: �Q,on�� ZIP• 553's(o <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> � � - <br /> PROJECT INFORMATION: Description of pro'ect: � � � <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Dispos I& <br /> �struction ingle Family with ❑Accessory Bldg./Garage Water Supply <br /> /� C <br /> ddition attached garage ❑ Deck <br /> ❑Accesso Buildin �Public Sewer <br /> ry g ❑ Single Family with ❑ Office/Commercial �� <br /> ❑ Relocation detached ara e � <br /> g g $Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ��7 <br /> ❑ Public 4-feet or greater �'Public Water <br /> **Any earth movement may also require ❑ Commercial ❑Storage �' <br /> MCWD review&permits. ❑ Industrial ❑Warehouse � <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well l <br /> ( ) ❑ Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 2.��� �p'� <br /> Last Updated: January 2015 <br />