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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �/ t7 —d.(/1 <br /> 41(1� PO Box 66 <br /> \ Crystal Bay, MN 55323-0066 a Date received: of/v�// <br /> Street Address:' D Received by: - <br /> yF LV 2750 Kelley Parkway ;I III' <br /> review fee: y/ b /. 0 5 <br /> ���ss H oma Orono, MN 356 t-5 eirk) / 00 <br /> Main: 952-24f-4600 Total Fee: G'- . . <br /> Fax: 952-2,•-4616 www.ci.orono.mn.us <br /> This application form must be '•mpleted in full and all required information must submitted. <br /> Incomple • applications will be returned: (Please print) <br /> GENERAL INFORMATION: // 765 .gD� <br /> Job Site Address: 1 (p 1 g(411,:--5 Po;In-F- Sc, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Q 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: -Thr 64,,.;•/,-,,,,4i r.-. 670,-(11 n elL 4r, L.L(_. <br /> State License# '4 c 6 3 cj 5--'�, :3 ' Expiration Date: :373///q <br /> Phone: (cell) OZ- --7.5-t.-. 3UZ.-, (office) biz - i/y/ - 33 <br /> Mailing Address: z,-7•-• , a Cit : _ di; • ZIP: 5Cy <br /> Contact Person: �t i,, 4Applicant is: on rac or, / Homeowner (circle One) <br /> Email and/or Fax: ,ktJ 4.)-Ice;1,7,1. t o,,yn <br /> PROPERTY OWNER INFORMATION: <br /> Name: Si 11 4 ‘:::%vklte Sin Yc. ,-- <br /> Phone (day): SO- 4;01 - Z'ii Z <br /> Address: iit) City: Q.'o.i, ZIP: 6-3-3q / <br /> Email and/or Fax tki IA It c,.4-►-')( Yedt)iriarit*i 4'1:,;I. C4.✓h <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: T - -' - 1 J5C retro 12 <br /> Phone (day): — <br /> .a^r�J (' c C ' �.•. <br /> - — <br /> Address: fZfl,L AOL,.crey,t1City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Add y '•- ie.1 /A t,-) 5,4t 4-e <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction (,Single Family with tfg Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck y[Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage (Residence E Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ 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 . L 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.minnehahacreek.org <br /> 0 <br /> Estimated Construction Valuation (excluding land) $ C�, h1�� RECEIVED <br /> FEB 272010 <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />