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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0l V Mailing Address: Permit number: lc•a)aaa <br /> PO Box 66 car <br /> Crystal Bay, MN 55323-0066\ Date received: o�`off �� /� <br /> Street Address:' CQ I�i � Received by: y <br /> l•� L` 2750 Kelley Parkway �! Plan review fee: j )4o ,93 <br /> lgkfSHoo- Orono, MN 55356 QC� - <br /> Main: 952-249-4600 vOGi$- <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. 1 94 <br /> Incomplete applications will be returned. (Please print) eR <br /> GENERAL INFORMATION: <br /> Job Site Address: ?39r'r4'VP ,Poo <br /> Will this be a Parade of Homes, Remodelers Showcase 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: E VV/f/OA/ i7' ' bfewge.... ,/ AN/ t44-D f/riC <br /> State License# 7 0 3, 4 S' Expiration Date: 3 -7/ - /6- <br /> Phone: (cell) b/;)-. - .2Z)—5 /g 3 (office) <br /> Mailing Address: 9,5 't tN A-v -. (V a, City: (Po A1p/ ZIP: 4130 5-C?6 j <br /> Contact Person: vr - /LAY M PAN Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: //./O-fi /2 4/ 0 1; 77f / G/VO/' 6457 <br /> Phone(day): ( ? - , -- ,.7 ,2 <br /> Address: -7 3,0 64.A/P 2 ' I City: a?t/NJ 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: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ®Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage <br /> CI ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation �f,�ioQt,G/�6 detached garage ) Residence ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo 0 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 /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ a� .i&P <br /> Last Updated: January 2016 <br />