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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,�l MailingAddress: Permit number: <br /> ��Wt's<lict <br /> PO Box „VT-0041.30'2 <br /> Crystal Bay, MN 55323-0066 Date received: 3 ---/-/3" <br /> 1‘))')v'�" Street Address:' Received by: 11,_~` <br /> �" #333.010 <br /> � 2750 Kelley Parkway Plan review fee: <br /> sH0Orono, MN 55356 c9018-0033 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application fonf1 must be completed in full and all required information must be sub `R d. <br /> Incomplete applications will be returned. (Please print) I 0 <br /> GENERAL INFORMATION: �� o p' <br /> Job Site Address: y3 0 B,' ii fl c d S', <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? E YesNo <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 ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO ATION: p <br /> Name: /NCGOecc7'/Z @Srh .DCI ike... c, <br /> State License# QC 6 Y. 4$-2. Expiration Date• 3-3/-/7 <br /> Phone: (cell) 7S--2 - z/� - 966' (office) ( „rR dr CP/ <br /> Mailing Address: 1303.3 R, c6, hi' tk J2r City: P , ZIP: 5---s--30s- <br /> Contact Person: a , ,c,c,., Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: Ai., c Ate rz oC.aori 1- ,/,1 , i i japes c 0,". <br /> PROPERTY OWNER INFORMATION: <br /> Name: %dY7r9-- AM-AZ/ 44044/0/„.<7 <br /> cr <br /> Phone(day): 7(:) - $� 9 -o-s6 Z <br /> Address: 5'3 O Bibi....)/7 /Q ace a1 ,,S, City:k 75' .7 ZIP: Sj S 3'` <br /> Email and/or Fax indit/O tJ/rkyry,`n CD rQ/,oo , c Os,- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> / J n <br /> Address: 4///�// 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 New Construction Ea Single Familywith 0Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck <br /> ID Accessory Building, ❑ Public Sewer <br /> 0Single Family with 0Office/Commercial <br /> ❑Relocation ih detached garage ,! Residence 0 Private Sewer <br /> ig.Other:(specify)/EQ.#w ,cq 0 Multiple Family/Condo • -etaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse <br /> 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 15320 Minnetonka Blvd ( p �) ❑Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 / <br /> Fax: 952-471-0682 <br /> www.m i nnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ .3_ , DOC' <br /> Last Updated: January 2016 <br />