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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS /�, 7� <br /> O Mailing Address: Permit number: / 7 —a 14� <br /> PO Box 66 <br /> O Crystal Bay, MN 55323-0066 Date received: `� ��—/7 <br /> Street ono, MN Received by: -- <br /> ti� L�illIlL 2750 Kelley Parkway Plan review fee: <br /> t-1'FESNO0- Orono, MN 55356 0/fp/ 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I cOrPCR.- bri V t <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 1No <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: (k.e_-- C.o>~c.it.li LL (- <br /> State <br /> State License# Q c_ -to 0 X23 Expiration Date: <br /> Phone: (cell) 6 i 2 11 q 5 3 ii-( (office) <br /> Mailing Address: y / I i Cit : 44.-0 a ZIP: -z, <br /> Contact Person: Br�‘,,,,, r, ,#-'-.. kevk ,77\-,w kr---- Applicant is: on r-c or / Homeowner (Circle One) <br /> Email and/or Fax: 'Lent ivv(d a "c 4- I.,Lc , 4..,--"-•-- <br /> PROPERTY <br /> ,.y„LPROPERTY OWNER INFORMATION: <br /> Name: 'P,•e,.,ti'ww. fr-dr 61,-0- <br /> Phone(day): qi-Z." 210— wK2- <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: tj N <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 /> E l New Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> Relocation detached garage ❑ Residence 0 Private Sewer <br /> Other: (specify) (aj+i"4-'t 4- 144"""M 0 Multiple Family/Condo ❑ Retaining Wall(s) <br /> 0 Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require 0 Commercial ❑Storage <br /> MCWD review&permits. 0 Industrial ❑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.orq ---_., <br /> Estimated Construction Valuation (excluding land) $ L'/ / 5' ' RECEIVED <br /> DEC 12 2011 <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />