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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> *At. Mailing Address: <br /> PO Box 66 Permit number: /`7 — 1)0 ?4/ <br /> Crystal Bay, MN 55323-0066 Date received: /Street Address:' Received by: /62750 Kelley Parkway Plan review fee: 1kESH04Orono, MN 55356 otal Fee: .:= 0(;) l -7 `vv <br /> Main: 952-249-4600 <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. 56, <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: 7/7 <br /> Job Site Address: 1510 OLS Com-` -ram gR-.( . <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: Ou-t' c..o.PE.S <br /> State License# scADs-1 %3 Expiration Date: s/-i /-yolk <br /> Phone: (cell) to Sq q_6-40 3 (office) of 57,--e1 ZLP- (08499 <br /> Mailing Address: , . T Cit : - ZIP: S' S10 <br /> Contact Person: - ��,� --�o .,�.sc� Applicant is: • rac or / Homeowner (circle One) <br /> Email and/or Fax: - --ro �( -rt›,vol--E -c.. . <br /> PROPERTY OWNER INFORMATION: <br /> Name: ty -T2o•y? <br /> Phone(day): �v�-r - g 40 -7,442.)0 <br /> Address: 81 oC...31714$-C « -( tib City: o .oa o ZIP: SS3' <br /> Email and/or Fax o,,N-c n,,0,)p r o e_:,--.0%4 ilk. C.a t•+. -_ <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 ElAccessory Bldg./Garage <br /> '®.Addition attached garage ',Deck ❑ Public Sewer <br /> ❑Accessory Building El Single Family with .]Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> El Other:(specify) El Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require El Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial El Warehouse 0 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.orq <br /> Estimated Construction Valuation (excluding land) $ 3S� 000 <br /> Last Updated: January 2016 <br />