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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,O Mailing Address: Permit number: =;-2,015-0-0578 <br /> V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: rj _� I <br /> Street Address:' <br /> Received by: <br /> ��. 2750 Kelley Parkway Plan review fee: <br /> `gkESHO�� Orono, MN 55356 <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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: o2 q q O d (d- &C, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes UNo <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 kill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT INFORMATION.�(, <br /> Name: �tkC �i va <br /> State License It Expiration Date: <br /> Phone: (cell) 101 (office) 95 a - 4-14 -5ga� <br /> Mailing Address: �4qp _O d- ,, xac-,k City: /,jn*2,r4.- ZIP: , �g <br /> Contact Person: -Sa K-k- Applicant is: Contracto / omeow� (Circle One) <br /> Email and/or Fax: e-, coo-, <br /> PROPERTY OWNER INFORMATION: I <br /> Name: �acaU�II'V1 °'�" S�Qwrl 4e.- <br /> Phone (day): a - 4-7 H q0 <br /> Address: qp city: O ZIP: j�3q <br /> Email and/or Fax � 1,10 w n . M c�/yt-cC av Maso n. cz o- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A IexcLwQk t, <br /> Phone (day): 5, - �l 7 - t-7 7 7 / <br /> Address: -/0 City: fyw,3 u"t-� ZIP: ��Sq <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ZI New Construction §4 Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ® Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage 0 Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Retaining Wall(s) <br /> ❑ Public 4-feet or greater X 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 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n n e hahacreek.o r <br /> Estimated Construction Valuation (excluding land) $ ico, 00y <br /> Last Updated: January 2015 <br />