Laserfiche WebLink
CITY OF ORONO 201`7 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> likts <br /> f VOMailing Address: Permit number: c 7/41-Ot�5ot7Received bPO Box 66 <br /> Crystal Bay, MN 55323-0066Date received:Street Address:' �y:2750 Kelley Parkway Plan review fee: O,ontO(3 Orono, MN 55356 p 5V <br /> Total Fee: �r�-0�'L9c� <br /> T <br /> ID at,/ <br /> 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � <br /> This application form must be completed in full and all required information mus :_ •..' d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: F'10 OC G:_/2 y 9L. 6.4 y /2 c7 .0 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes eNT 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: ,4 GAIT,5 S <br /> State License# Expiration Date: <br /> Phone: (cell)6//. (office) 763 -5-6c) - 0/0 3 <br /> Mailing Address: /c c c 73n1•o AJ(' . '-z. roc_) City: ,-74*,z c,cl,ZIP: 5-5-36-F <br /> Contact Person: /0 c j� Applicant is: on ractor / Homeowner (Circle One) <br /> Email and/or Fax: u,:-17 (6meq,—G�9r�.—.�S A, cs <br /> PROPERTY OWNER INFORMATION: <br /> Name: T;`/`—t ,LL,li4/`t S <br /> Phone (day): oG <br /> Address: Cay 5%t L /3A y /2-2 City: C ,'2 ,L-)p ZIP: 3 3 / <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: &�u0 02 o X Ll S rNG 2.ad/40 Poe) L <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> • Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> IE • her: (specify) Two/c/) ADL ❑ Multiple Family/Condo ❑ Warehouse <br /> 0 Public <br /> RI:).torage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercialthey(specify) <br /> MCWD review&permits. 0 Industrial .5'w - i 'o L ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ LI>/ Uov <br />