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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION - -. <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O�r Mailing Address: Permit number: SOI �G�O j <br /> LV,041 Mailing <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: i - �`— <br /> Received by: <br /> a Street Address:' /!'I <br /> S* G`* „,,,ty,.., ,,,,, 2750 Kelley Parkway Plan review fee: $ �/r'', -IlkESHO ' Orono, MN 55356 . cI L 00-5—V <br /> 1 ,o 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. (Please print) <br /> GENERAL INFORMATION: q <br /> Job Site Address: RV. 7 Far of e u L yi a <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ 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 INFORMATION: <br /> Name: /)©r-een (y...)ii4 -I-+'j-, <br /> State License# 8.C. 3 S/o/y Expiration Date: _. 31 -/ <br /> Phone: (cell) 6/c2-- 7 - 3 g4 G (office) <br /> Mailing Address: 26,3-- 3 rat 6-1: v Cit : yo ZIP: S,S3a 8 <br /> Contact Person: Ji vy` Nov`-e'en Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: J d ytpr re-e., 0 ivi4.7 - Cpm <br /> PROPERTY OWNER INFORMATION: <br /> Name: M4 ari+ Gcd8 ci rri'S <br /> Phone (day): c`Yx-' C,Ga-3 45--5 <br /> Address: oZ''Ia,7 F41”-vreg.v L—n. City: Or^ofr?D ZIP: <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: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction <br /> 0 Single Family with 0 Accessory Bldg./Garage <br /> ❑ Addition attached garage 0 Deck <br /> 0 Public Sewer Accessory Building 0 Single Familywith 0 Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 Private Sewer <br /> ig Other: (specify) I,/� , r)Yt yr) &nrtiel 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> A/eu> Lt, - ou.) 0 Public 4-feet or greater 0 Public Water <br /> "Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) ❑ Private Well <br /> 15320 Minnetonka Blvd ( p �) 0Other(Specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> — <br /> U <br /> Estimated Construction Valuation (excluding land) 30� O> '� <br /> Last Updated: January 2015 <br />