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<br /> CITY OF ORONO / 6.&-9. . ,
<br /> BUILDING PERMIT APPLICATION /
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> A� Mailing Address: Permit number: coo/8-dd a/'�
<br /> ��`v,O� PO Box 66 �y
<br /> Crystal Bay, MN 55323-0066 , Date received: o3 -? 7-/O
<br /> a , Street Address:' �� Received by:y� L` 2750 Kelley ParkwayKjCi\'
<br /> Plan review fee: `7 / b?l8 5`.ktSH00' Orono, MN 55356 cAdi P-D-04-7N)7
<br /> Main: 952-249-4600 Tot ee: .,l
<br /> Fax: 952-249-4616 www.ci.orono.mn.us SC / OO , - UV
<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: '-S--2,C-,C , Nor 5\fvoi Dc ave,
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes RI 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 I APPLICANT INFORMATION:
<br /> Name: AIIii CoV6tft,c-1-1dr 11-6
<br /> State License# j5C 6757,3c Expiration Date:
<br /> Phone: (cell) 015z. 737. vols. (office)
<br /> Mailing Address: 5935 Dv.,10:,r_ LA g City: m„A,, ZIP: s5q1/(
<br /> Contact Person: Rab t.Y,Is,n Applicant is: ontr ctor / Homeowner (Circle One)
<br /> Email and/or Fax: All;eo4ConSir•uach')M0®c)wl5;l•Cdya
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: ljCo,-k- Fell lc vi 1'`1
<br /> Phone(day): 61 Z. 30 1o2-7
<br /> Address: 32C,c. tdew1V+, S1nr,-o Dr:-e, City: Ot-o110 ZIP: tk ll:t,►;4 4
<br /> Email and/or Fax Sc.;)1±.sscr,IV_LAy ci)cyi,sA,C.0b,.1 sc`ni..
<br /> visi
<br /> ARCHITECT/ENGINEER INFORMATION: Wu* ISarni2a.k 1(O3 -3n-08q'-
<br /> Name: R i S /4rc,k -P, iln5cAl0 @sambal-CK.Cara
<br /> Phone(day): 6) .. -- uj r'167.-
<br /> Address: tf-c100 M L a� d d/ u,re, 0 City:0
<br /> 2,V'+ "�.
<br /> %ZIP: ,� �� ,�
<br /> Email and/or Fax: � -i-Dr\Re,v1� Goric&r}-.nom
<br /> 5 j 'Zk'
<br /> PROJECT INFORMATION: Description of project: 1-1. r,+z., I-/‘ * De is v A Cc,.---.3 Q,
<br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
<br /> Water Supply
<br /> ❑ New Construction lg Single Family with
<br /> Addition attached garage Accessory Bldg./Garage
<br /> ] Deck Public Sewer
<br /> Accessory Building ❑ Single Family with ❑ Office/Commercial
<br /> Relocation detached garage El Residence
<br /> 0 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 g 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.m innehahacreek.orq
<br /> Estimated Construction Valuation (excluding land) $ 173/000
<br /> ` CI 1.)3 M W 0 ,
<br /> FEB 2 7 2018
<br /> Last Updated: January 2016 CITY OF ORONO
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