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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: -(-)C)7/ <br /> V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Received by: /2!✓ <br /> Street Address:' _ p <br /> y� G. 2750 Kelley Park wa -'`l (' (,�0,1 1 I Plan review fee: Q q <br /> ESHo�� Orono, MN 5535;"_D� "__ <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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: <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 servicev8ill 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: <br /> State License # CSL-lZ`f oos Expiration Date: S}3/ + -7 <br /> Phone: (cell) LSI _ �S„� _ 3� ZZ (office) - <br /> Mailing Address: Cit ZIP: <br /> Contact Person: �_� Ste- Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: (y�� S��i �•i�. <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Ocs-.=- -J <br /> Phone(day): Pq y_ C o tiz <br /> Address: City: °�>--, ZIP: <br /> Email and/or Fax: M: <br /> PROJECT INFORMATION: Description of project: _�, <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New ConstructionWater Supply <br /> Singie Family with ❑ Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> E]Accessory Building El Single Family with ElOffice/Commercial Public Sewer <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> [ Other: (specify) L_E:�t ❑ 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 <br /> Minnehaha Creek Watershed District(MCWD) El Private Well <br /> 15320 Minnetonka Blvd ❑ Other: (specify) ❑ Other(specify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.orc <br /> Estimated Construction Valuation (excluding land) ZcxU � Oc)v <br /> Last Updated: January 2015 <br />