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• CITY OF ORONO <br /> NOV 17 2014 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS c-- 7------ <br /> -- - <br /> �O` ` Mailing Address:PO Box 66 Permit number: ,-- 6)/1--/ "41� � <br /> 0 Crystal Bay, MN 55323-0066 Date received: //-/7—/5i <br /> Street Address:' Received by: �� <br /> y • 2750 KelleyParkes 1"' CK—.2 (O . <br /> 11 ff Plan review fee: <br /> `� Orono, MN 55356 1 �1 �� <br /> lgkESH0°' <br /> Total Fee: <br /> Main: 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 must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION:„\ , 1 �j i <br /> Job Site Address: 1310 V�ove-c l- 1Q ?)1Q o rbc- t I l�oi <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0,10 <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 OR�VIATION: \ <br /> CName: _2orc s c---,02S nS � °''-1 1 ‘r.C. <br /> State License# ..3 C.5 3 1 Expiration Date: 3/•;t S <br /> � , <br /> Phone: (cell) (Isl..- i, i- gq 0 (office) '�.O; 4-49 - 311 q <br /> Mailing Address: Sty) Isla.:., S-i. Qo W3oy%. "306 City: R.:, ZIP: S'S3S1 <br /> Contact Person: -.......\,...1.-\,...„_ ifc ' d Applicant is: ontra for / Homeowner (Circle One) <br /> Email and/or Fax: i�1�„4, ( _,��c n — J ¢S• c v �� '�c3.. Li-3-`i- m14 <br /> J � <br /> PROPERTY OWNER INF RMATION• ,�-`` f(�� AA <br /> c <br /> Name: av � CIO-LLA. "-es.' O-X a .s. 4L5 <br /> Phone (day): (=A2.- - i—to• ci't•33 • 5-5%-to ( <br /> Address: '-►5. AL. I -Sd= IS-I'-i City:/"`•^".'"Y`'Q' % ZIP: <br /> Email and/or Fax C4a _r t S42e M e c� �„�c�v� C <br /> . e G�,a Le, e en C . C.2.en S-c <br /> ARCHITECT/ENGINEER INFORMATION J J J — �rc�� F . C-cr� <br /> Name: La&*J t r4eIA CAAT-.aA LL C <br /> Phone (day): _StZ `E- '2— S- ci t t 1 1 1 <br /> Address: t400 ,�.n„acL-e, �.1City:Vv.n� a.r.,S .. ZIP: Cc `i <br /> Email and/or Fax: q« c,nt , Aeve 1,,,tati Q. CvA. <br /> PROJECT INFORMATION: Description of project: <br /> — <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> Ertiew Construction )4ngle Family with ;gc.. esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. Ajublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> 0 Other:(specify) 0 Multiple Family/Condo ❑Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial *Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) $ 00 ®d <br />