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VC UJ <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> / MailiPO Box 66 ng Address: l Permit number: >/7 — C' <br /> Crystal Bay, MN 55323-00 h�j'vt Date received: �'t <br /> ` a 1 �✓ 1 Street Address: / Received by: o <br /> �`�t �:; �►{I 2750 Kelley Par `ay Z O l 7- <br /> Main: 952-249-4600 oV Ian review fee: , O ' <br /> �q 5� Orono, MN 5535 <br /> �----- 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: 37 �t1�c '1�r,✓ /�/" <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 IN RMAfiIOnN: <br /> Name: 61 ! = <br /> State License# Expiration Date: <br /> Phone: cell ?_—ZZ 1--7 Z G office <br /> Mailing Address: Cit :uf ZIP: �t <br /> Contact Person: Applicant is: Contractor / omeowne (circle one) <br /> Email and/or Fax: �r^/�Z� � yt� L, Cn, i 7�;7- `f76-b -7 o�. <br /> PROPERTY OWNER INFORMATION- \\ <br /> Name: Uc 44L <br /> Phone (day): �i/ -ZZ 1- '7 Z7 4 �� � <br /> Address: Pro. C3 .,->e 9S/ City:��%/"71!1? 4- ZIP: <br /> Email and/or Fax 77fe l- 47 g-Y b?o.. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP' <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description ofproject: G �F �44 <br /> 1.Type of Project 2. Proposed Use 3. St_rw6ture Type 4.Sewage Dis osal&/ A <br /> Water Supply W <br /> F1New Construction &Single Family with ElAccessory Bldg.(Garage <br /> ddition attached garage ❑ Deck gWublic Sewer <br /> tl Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage residence <br /> [gZlther:(specify G,�f!} (i�� �.,'S ❑ Multiple Family/Condo El Private Sewer <br /> p y El 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 <br /> MCWD ❑ Private Well <br /> Minnehaha Creek Watershed District <br /> ( ) ❑ Other: (specify) El (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) $ Z/ Or az <br /> Last Updated: January 2016 <br />