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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS O 0, g9 <br /> iiLiD A Mailing Address: Permit number: c=7:70O�D/ — d�d 7 <br /> lVO,. POBox66 <br /> Crystal Bay, MN 55323-00 Date received: / ��-1 <br /> Street Address:' 1 <br /> 2750 Kelley Parkway '',/..,/\W � Received by: 4- <br /> y� iv— <br /> G�� Plan review fee: <br /> `�xH <br /> ESo4'� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: , iy ,,/,, 4 *)dr <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: 1 e4o L- v IEt,0 DC2Ac . <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: KAOK- t t-{LOC- <br /> State License# Expiration Date: <br /> Phone: (cell) fa t2, 1501 (c,c (o (office) <br /> Mailing Address: 500 kb Expojci4 rO City: 1'Y1 iut,A-m tc n,, ZIP: 5-53s <br /> Contact Person: ILc,is...‘ E �lApplicant is: Contractor / omeown (Circle One) <br /> Email and/or Fax: ` ko rii r1P\- r- i►�c hotrv-I Pt►L.CsDr✓1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��-E��� <br /> Phone (day): lo V-2_ 1 (oD'i <br /> Address: 500 oitiirk arZOt�c-Ak IZo City: 0Awkic.- teicil ZIP: 5S3S'� <br /> Email and/or Fax k o rLA 0-)e\CI‘er 11->c 2 ino�-rvt r>`k.t_ ,cx,rr <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 /> Single Family with Cl Accessory Bldg.I Garage <br /> ❑Addition attached garage ❑ Deck El Public Sewer <br /> ❑ Accessory Building 0 Single Family with ❑ Office/Commercial <br /> 0 Relocation detached garage 12,Residence 0 Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family I Condo 0 Retaining Wall(s) <br /> 0 Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse KPrivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ 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) $ +.5 I Dcc 00 <br /> Last Updated: January 2015 <br />