Laserfiche WebLink
I I <br /> . CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� MailingAddress: Permit number: 2�� . (p - ��� � j <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � � <br /> StreetAddress:' Received by: __ � <br /> y�. G�'� 2750 Kelley Parkway ���� �a I� lan review fee: f . <br /> `�k E S H��� Orono, MN 55356 C 1(, -��.3 y "�j <br /> Main: 952-249-4600 Total Fee: Q <br /> Fax: 952-249-4616 www.ci.orono.mn.us ji - ✓ ��9(� �] , { <br /> This application form must be completed in full and all required informatio must be submitted. <br /> Incomplete applications will be returned. (Please print) �t��� `���� ;� /l <br /> GENERAL INFORMATION: � <br /> Job Site Address: �(,��, � ��,�C��'� S�� "�r l�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes °�Alo <br /> lf yes,a specia/event permit is required with Police Department and City Counci/approva/60 days prior to fhe event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL,ICANT INFORMATION: <br /> Name: 1-{�rn�'S �j,�� L;t�co��`� <br /> State License# L- Z,,, Expiration Date: <br /> Phone: (cell) (��Z^ Z�� �- ��� (office) (Q� Z � ���-- cP'z-�5�' <br /> Mailing Address: �- � --r Cit : �' -� ZIP: <br /> Contact Person: 5'�'�-( L-��.-.� Applicant is: n rac�ri / Homeowner (Circle One) <br /> Email and/or Fax: _��-f I-( r� �'r,�:�� i'i�L��-,,��t�,`.�r�ES . c o�,.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,��,�1 ��SSL-�C'`. <br /> Phone (day): q5Z� 2�� - 'l7 <br /> Address: 3bR3 or�r}e Srt (� -�o �V�, CitY� �fLoN� Z1P: 553�5(0 <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: • �- �C�7`J � � ��`L'f' � <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Dispos I& <br /> Water Supply /,�'� , <br /> �P4ew C nstruction ingle Family with ❑Accessory Bldg./Garage <br /> ddition attached garage ❑ Deck f�Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ��.% � <br /> ❑ Relocation detached garage �flesidence ❑ 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 8 permits. ❑ Industrial ❑Warehouse ''���' <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(SpeCify) ❑ Othe�(speCify) ' <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 2.��� �p'� <br /> Last Updated: January 2015 <br />