Laserfiche WebLink
CITY OF ORONO q <br /> BUILDING PERMIT APPLICATIO 1 �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � kv <br /> Q�r Mailing Address:�O Permit number: o/(c-C O 7/ <br /> PO Box 66 <br /> \� Crystal Bay, MN 55323-0066 Date received: <br /> Received by: <br /> Street Address:' <br /> 2750 Kelley Parkway t,�dl 1q .Plan review fee: 0l�'YESROIL�G Orono, MN 55356( __ <br /> �J tea... <br /> Main: 952-249-4600 <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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: LZp 0o7---V_,\C E;ra <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes R1 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 dill 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: L ku Z__ <br /> State License# 6S yA-Ll Expiration Date: 3)31 <br /> Phone: (cell) (.S( -�5�� _ 3� zZ (office) - <br /> Mailing Address: <br /> � ZIP: <br /> Contact Person: <br /> -, A 5�-.� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: r ��.-.5 1� �-� .��v�. : 1-�,�.c •-. -_... - <br /> PROPERTY OWNER INFORMATION: <br /> Name: tUt_,D SC�L� �•a1. <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 134 L- acs=�-J <br /> Phone (day): y_ r cs�z <br /> Address: city: Zip: <br /> Email and/or Fax: <br /> No-i -�co V <br /> PROJECT INFORMATION: Description of project: E <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New Construction Single Familywith Accessory ry Bldg. Garage <br /> Supply <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) R�tiL ❑ 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 Other:(specify) ❑ Private Well <br /> 15320 Minnetonka Blvd ( p ) ❑ Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ Z.ou , ODO <br /> Last Updated: January 2015 <br />