Laserfiche WebLink
r <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> VOA/ Mailing Address: Permit number: .(JI _ OOO ' <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: j/cf//Sf <br /> Street Address:' Received by: 1/ <br /> ti `, 2750 Kelley Parkway Plan review fee: -0 �j'SJ., O 2 J-, <br /> F <br /> I1KESHov-� Orono, MN 55356 �6I$-000s -j-- <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us 010/6 DCOD,`"') $l0t� <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: 4Z0 LA-tot V‘t''vi -iu-G 1n " <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: 0 N1 . A t�•..... <br /> State License# f>C CV Z kVA Expiration Date: <br /> Phone: (cell) Gil g4.4, l kept (office) q'A 3 43 2.. 4400 <br /> Mailing Address: 1 066 3 66 Nil. 4%4. >J a 4Gb City: C.,%.,..,€,...,,V.1ZIP: S 1-tZ-' <br /> Contact Person: to M.‘SLu Applicant is: Co •r / Homeowner (Circle One) <br /> Email and/or Fax: kJ M t11 a %j4 1,,L, Q G o JviE A wt, Mtn• Gone\ <br /> PROPERTY OWNER INFORMATION: <br /> Name: (1-om E 4 14-oM ei <br /> Phone(day): - L 3, 437, 45-DD <br /> Address: 1 ODA Soo kiA A-vv 'V# YDO City: GL,E A,1),_y ZIP: Sic 42,:i- <br /> Email and/or Fax N M t TG W—E LL 4,0N1t A oM tr'S . Co,/V- <br /> ARCHITECT/E Glf‘E_Eji INFORMATION: /�SI�I" <br /> Name: - VOA E '+ /n5e�t4�Y.S <br /> Phone (day): _ <br /> Address: 44 3 S ILLS Q.' it To 4- City: 6 1t -4-N ZIP: j 5-1/1_ <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 /> aNew Construction [Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck El Public Sewer <br /> ❑Accessory Building El Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence 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 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) $ tet'$c/ D o O <br /> Last Updated: January 2016 <br />