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' , . r <br /> . � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� MailingAddress: Permitnumber: � -D/030 <br /> PO Box 66 <br /> O Crystal Bay, MN 55323-0066 Date received: �`" <br /> _ ___._._..._�_ Received by: ,.� <br /> StreetAddress:' r- f� `4! <br /> yF G� 2750 Kelley Par ay �� �� Plan review fee: L <br /> �y �, Orono, MN 55 6 �'r� %�� _�_ <br /> KES H�� Mai n: 952-249-4600 <br /> Fax: 952-249-4616 www.ci.orono.mn.us � � �v�� � � <br /> This application form must be completed in fuil and all required information must be submitted. � <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��9� �UC��, r�'}� �r�V� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special event permif is required with Police Department and City Council approva160 days prior to the event. Shuitle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP,4ICANT INFORMATION: <br /> Name: Nor�vr-� N���e S, L � � <br /> State License# BC [�3S}�--I Expiration Date: 3—,31 - / 7 <br /> Phone: cell) / }- 3$(0, � office ?G . S$�- 9/ <br /> Mailing Address: /�a-/ �+- , /J Cit : rn,t/ � S,5"yy <br /> Contact Person: ri Or Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: G r� ,/'1 C4ih.. <br /> PROPERTY OWNER INFORMATION: <br /> Name: �(�t S N C1r'-,—dv�. <br /> Phone (day): (o��- - 3�(,- 7 S�L � <br /> Address: /'�:t-/5 y�r� /�,�z �/ Cit : ,. L, ZIP: — � <br /> Email and/or Fax C 1'iSivc2�/lu%-��-���µf3 , Co ��z <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �f' P �1CLrYY1�'r1u � �S i�i n <br /> Phone (day): �(�3•'7 • r60UY �� Q <br /> Address: 9/du 8a-�r�%n�n-e Sf , /�/F S�- /O� City: U�Q.�r�-� ZIP: SSYY�J <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: Description of project: � t,l.�� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> � ew 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) $ �UD DDD <br /> —� <br /> Last Updated: January 2016 <br />