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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 f 1� Date received: f r / / <br /> l g f <br /> Street Address:' Received by:h' r <br /> ti� r✓� 2750 Kelley Parkway I l Plan review fee: 02/ <br /> `q k1 Ho�� Orono, MN 55356 2C(7- <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us �row ✓ <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: 130c __�-a*NCk CV"e. _� <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� INFQ�2�MAT % <br /> Name: �. L( N , <br /> State License# 54SSCS Expiration Date: 03 • 31 • zo `6 <br /> Phone: cell 41 Z. 1% • office 'IS-,L • -ItTb• dSfSZ- <br /> Mailing Address: ZA,03, City: M-- k<A . ZIP:5S3 <br /> Contact Person: Applicant is: ontrac o / Homeowner (circle one) <br /> Email and/or Fax: \ �i-►C�e�w�fN•Coyr� <br /> PROPERTY OWNER INFORMATION: <br /> Name: C., ,'s '� .nu L— <br /> Phone(day): tit 2 23 5!� <br /> Address: ;o.> OkmeN E;A�- �v¢._ , City:cD o,.ko, ZIP: '5535L, <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): -1103 7,%0.5Q04 Address: 'i l o J B�(v-,n Q4.6 1.l to . City: �j l.�+W'b ZIP: S <br /> Email and/or Fax: 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 /> ❑ New Construction Single Family with ❑Accessory Bldg./Garage <br /> ®Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(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) <br /> Last Updated: January 2016 <br />