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CITY OF ORONO 1515- .51 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OAj Mailing Address. Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 553213-0066 Date received: <br /> 0 Received by. <br /> Street Address:' <br /> 1 2750 Kelley Parkwa Plan review fee.- <br /> e SHO Orono, MN 55356 5 AD 1-7 (It t3 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> Too, <br /> GENERAL INFORMATION: - <br /> ' - <br /> Job Site Address: 4 S2,S 7�,eC,_C- <br /> Will this be a Parade of Homes, Remodelers Showcase Home oro her Display Home? ❑ Yes allo <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/AFLICA�T INFOR"TION <br /> Name: _(As V-C VV\- t--c 0 <br /> State License# 50Q-2:1 Expiration Date: 037 -3) /IR <br /> Phone: (cell) (office) C1 52- -q 3'--z, �D- <br /> Mailing Address: S15'7 t,-;,) City: V Ic I r)-:., <br /> ., ZIP: -3 <br /> Contact Person: Applicant is: (: ontractor Homeowner (circle one) <br /> Email and/or Fax: VA r) e--LA S-hn I'V, 00 1,5�- 1 el C- - CO K11 <br /> I V <br /> PROPERTY OWNER INFO7%TION. <br /> =5 ( <br /> Name: I LI <br /> CLe <br /> Phone(day): <br /> Address: �?-fc,- City: Dcupyin zip: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descrip ion of project: IA "r-) SfA 2 <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> El New Construction El Single Family with El Accessory Bldg. Garage <br /> El Addition attached garage El Deck El Public Sewer <br /> El Accessory Building El Single Family with El Office/Commercial <br /> El Relocation - detached garage El Residence El Private Sewer <br /> El Other:(specify)Th�-�Q L/-,rl El Multiple Family/Condo El Retaining Wall(s) <br /> SwtU <br /> 19OC2 D Public 4-feet or greater El Public Water <br /> **Any earth movement may al require E]Commercial El Storage <br /> MCWD review&permits. El Industrial E3 Warehouse El Private Well <br /> Minnehaha Creek Watershed District(MCWD) El Other:(specify) El Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacmg"-Or <br /> Estimated Construction Valuation (excluding land) coo <br /> Last Updated: January 2016 <br />