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CITY OF ORONO <br /> BUILDING PERMIT APPLICATIONif <br /> FOR NEW STRUCTURES OR ADDITIONS ffJr°Z. <br /> le.-0.41 Mailing Address: Permit number: s 3QJ7 ,/J <br /> O POBox66 <br /> Crystal Bay, MN 55323-0066 Date received: ,> -/9-'S) <br /> Received by: <br /> a ,, Street Address:' n <br /> 6� L. 2750 Kelley ParkwayNoi C( Plan review fee: 3 /t�k� o�� Orono, MN 55356 U <br /> sH Main: 952-249-4600 Total Fee: <br /> I F • �O/�`R23/ <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. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: qID `T --��_ V <br /> Will this be a Parade of Homes, Remodel Showca3.se ome or other Display Home? ❑ Yes ❑ No <br /> /f 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/APPIACAINT INFORMATION: i // L . <br /> Name: l 1 °i1' C ��c <br /> State License# kJ° • e„ Expiration Date: <br /> Phone: cell - -41e��AVAINAr. office --1 <br /> Mailing Address: -' , VA1Cr: .% .. M •,.- D: mom_ " <br /> Contact Person: Z la__41. _ Applicant is: "'' r / Homeowner (circle One <br /> Email and/or Fax: . <br /> PROPERTY OWNER INFORMATION: <br /> Name: /,.kri`s 4- L e- ILkU PA <br /> Phone(day): - - `_ . <br /> Address: A l o ( k- City: ZIP: . --.3 <br /> Email and/or Fax te-- 1e- , kyGe ± Q ; �� _ ,,5� <br /> ARCHITECT/ENGINEER INFORMATION: 11 <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 /> New ConstructionWater Supply <br /> 0 Single Family with 0Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck 0 Public Sewer <br /> ❑Accessory Building Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 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 /> MCWD 0 Private Well <br /> Minnehaha Creek Watershed District <br /> (MCWD) 0Other:(specify) 0Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> CT...... <br /> Estimated Construction Valuation(excluding land) $ _.34 % <br /> Last Updated: January 2016 <br />