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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �oMailing Address: g <br /> 1`j� Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-195 <br /> Street Address:' Received by: Cy F <br /> 6� G.'� n 2750 Kelley Parkway v Plan review fee: l ��, <br /> "I Orono, MN 55356 �_ <br /> `gkEs ti o Main: 952-249-4600 CROS <br /> Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us r r� <br /> This applicat�oAnform must be completed in full and all required information list be submitted. <br /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: - �� jE-0 - <br /> Will <br /> 0 .Will this be a Parade of Homes, Remodelers 8howcase 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: <br /> State License# Expiration Date: zj 31 I I l <br /> Phone: cell - --1 L office <br /> Mailing Address: _ 2-1,1(1 l=Air w city: ,� ZIP: C553 nr <br /> Contact Person: Applicant is: _ontrac / Homeowner (Circle One) <br /> Email and/or Fax: \ <br /> PROPERTY OWNER INFORMATION: <br /> Name: N C47-1 S�-.�1� +(��►a., <br /> Phone (day): <br /> Address: Z� �, ti�_�L�t lie- City / p ZIP: <br /> Email and/or Fax r\,e A,,\ca �" <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: z�,-, <br /> Phone(day): —7L+ <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 /> UNew Construction Single Family with Accessory Bldg./Garage Water Supply <br /> [:]ddition attached garage EIDeck /�-Public Sewer <br /> Accessory Building ❑ Single Family with ElOffice/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greaterPublic Water <br /> ""Any earth movement may also require El Commercial EI 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: 952471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> 4� <br /> Estimated Construction Valuation (excluding land) \� ) (-Do ' <br /> Last Updated: January 2015 <br />