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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION Rai-.- 7.,t <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �Ok Mailing Address: Permit number: p�0/ 00 AU <br /> O Cr Box 66 ^`A/!- <br /> Crystal Bay, MN 55323-0066 Date received: o� IP <br /> Street Address:' Received by: # /Y <br /> Se. L� 2750 Kelley Parkway \\� Plan review fee: J ��0'5 <br /> !ikEsHO��` Orono, MN 55356 t`�` OW/8-/7UvlQ3 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us &7/7-6/53/ _sem J <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: 1300 "blabr4c.L. e.etxk-• <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 0 Yes E 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: (r• t I ,.5tA` . <br /> State License# 5%Sew Expiration Date: 3. 31 • z�iS <br /> Phone: (cell) 1— ,% .--7-4— <br /> .%1 •T116 3 S (office) art• 47L •oSYL <br /> Mailing Address: o C v S.; ' t: _ Cit : __ • 1/1.44 ZIP: - <br /> Contact Person: _ Applicant i ontractor Homeowner (circle One) <br /> Email and/or Fax: N.c.-CALL t.�v►+t$•co v" <br /> PROPERTY OWNERERII(ATION: <br /> Name: s 1 <br /> Phone(day): wig. • pa, •.1;-s.�7 <br /> Address: 1300 ' n ore.4... t: f.k City: O'wwo ZIP: 5P'35(• <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �.•F,e, T+t,r.,.Aa*.s.y+ <br /> Phone(day): "14 s. .710 • Iwo 44 <br /> Address: yI0 2,4*.Lg,.,..61r1.4. 15k, N*--,. g:+a.G 106 City: TNLAirrt vv.w. ZIP: S544' <br /> Email and/or Fax: 4440 ta.i,' 4,4.m'C.ova, <br /> PROJECT INFORMATION: Description of project: <br /> - <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction I Single Family with ®Accessory Bldg./Garage <br /> ddition attached garage 0 Deck 0 Public Sewer <br /> Accessory Building 0 Single Family with 0 Office/Commercial <br /> ❑Relocation detached garage 0 Residence —p Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo 0 Retaining 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 /> ---p Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) $ L+0 000 PIECENED <br /> FEB 2 02018 <br /> Last Updated: January 2016 CITY OF ORONO <br />