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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0 Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006 /) Date received: 69 <br /> Street Address:' \✓ Received by: <br /> y <br /> 2750 Kelley Parkway Plan review e: <br /> �gkfsHo��` Orono, MN 55356 \ qq J <br /> Main: 952-249-4600 Total Fee: J) U / <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: EJrp C.tL. (0,0 ice. ou <br /> Will this be a Parade of omes, Remodelers Showcase Home o other Display Home? es 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 INFOWATION: <br /> Name: Aft! W_04-1 l.kWO-Al <br /> State License# Ex iration Date: <br /> Phone: (cell) (office) �qDCSO <br /> Mailing Address: (-Tt mih,I r-�, S , City: o ZIP: 55 <br /> Contact Person: O Applicant is: ��racf�r / Homeowner (circle one) <br /> Email and/or Fax: �1c a ver�'Ezh j Z <br /> PROPERTY OWN INFORMATION: <br /> Name: �� I�Qrt:A-1C. SC.- 4S <br /> Phone(day): Z- - <br /> Address: cCdA � WJFZ, � City: L' ZIP: <br /> Email and/or Fax \n�<'-­C; C. C C) 2 w�v\ . V.5 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: -1 V11 VIA CY-1 - , 1Lr5�� - ►'l�,s.� � _. '�►�, <br /> Phone(day): -S — 2r' , <br /> Address: 5 e Zai 1Z�'� city: � � ��� ZIP: <br /> Email and/or Fax: .? c , <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> VNew Construction ❑ Single Family with ElAccessory 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 Q Retaining Wall(s) <br /> 9-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 tJ <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � ,ocE� <br /> Last Updated: January 2016 <br />