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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: ��_Q47 <br /> • 0W <br /> Permit number �/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 r� Date received: //-1 —17 <br /> Street Address:' ((��,, d' Received by: /97 <br /> ' 2750 Kelley Parkway5 0� Plan review fee: '' 3 ._ 95 <br /> Orono,MN 55356 ) e� f <br /> Main: 952-249-4600 Total Fee: <br /> Fax 952-249-4616 www.ci.orono.mn.us ilify <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: 2-665 <br /> l�6s <br /> Sca � �.r...1-. Q.1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes &I No <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT IfORMATION <br /> Name: (_o,-c5')-n S Co <br /> State License# BC.S3 1 ci 6 I Expiration Date: I <br /> Phone: cell - _ 7 I - IR , office .- 4) _ 3111 <br /> Mailing Address: -I C 9 Mr.,;. S _ City: e,,,,,ZIP: <,-c3 S'_ <br /> Contact Person: . ,. w Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: \'6�,•J la <br /> rL-� `c e S , C,,�� <br /> PROPERTY OWNER INFORM ION: nn J /-� <br /> Name: c..0 s cX , Lvl,\ l ; / AN <br /> Phone(day): °ICI, - ccI - i`1 I y l <br /> Address: 2C6 S s c4.) e � - q- - City: O re)A o ZIP: 55391 <br /> Email and/or Fax Q_ol 1),..-It( M u.' L. m Svc . C-(sm <br /> ARCHITECT/ENGINEER INFORM TION: <br /> Name: <br /> Phone(day): •-}-b 3.- ' go - g UO Lj <br /> Address: alk Do ,,.,re S-1 . kik; Ske l0( City: ?`A,rJ ZIP: S5‘-k`1/4 9 <br /> Email and/or Fax: O c..d @_ d,, p c-k...ect1.A „ <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> tigiilew Construction tihingle Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deckublic Sewer <br /> 0 Accessory Building 0 Single Family with 0 Office/Commercial <br /> ❑Relocation detached garageesidence <br /> ❑Other:(specify) 0 Multiple Family/Condo ]Retaining Wall(s) <br /> ❑Private Sewer <br /> 0 Public 4-feet or greater ,ublic Water <br /> **Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation(excluding land) $ 06 ( 0 0 0 <br /> RECEIVED <br /> Lest Updated: January 2016 <br /> NOV Lull tj <br /> CITY OF ORONO <br />