Laserfiche WebLink
1 9 9 °3 <br /> CITY OF ORONO / f(0-6' ' } <br /> BUILDING PERMIT APPLICAT N <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ic:LO ` - MailiPO Bng o r66 Permit number: Q/L/ ` 4 J <br /> (�� Crystal Bay, MN 55323-0066 Date received: //../ /� <br /> 1 <br /> Street Address: Received by: E- <br /> ....., <br /> yF G`� 2750 Kelley Parkw &. CK- ____V_ _________ <br /> Plan review fee: <br /> �; Orono,MN 55356 12 �� Y.Y.t•kfSHOc'- <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us C (,it( olla7king-f Yt /►� <br /> This application form must be completed in full and all required information must IA submitted. <br /> 1 <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: `I 1 <br /> Job Site Address: 210 up,,v?c 0,iQ , .0 Vic- j I L_O t� c) <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 01,lo <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 OR4VIATION: \ 1 <br /> Name: _7o� c,•. ........10-,...e c> CAS ` °� , `r.C • <br /> State License# '.3 CS 31 1 (, 1 Expiration Date: -.6/• %1 (S- <br /> Phone: (cell) cis-L.- -Lk, 1- 89(„3 (office) -4-6; - 4191 • 3 `17- <br /> Mailing Address: 515) A c,,, S-4, Qo c 3Cx City:M�- Q „ ZIP: SS3S`� <br /> Contact Person: .k,,. v Applicant is: ontra8tor- / Homeowner (circle One) <br /> Email and/or Fax: �Gl.v„ ,,y - _,r o n ,SC-vQ S• Cr,��1 � 16.3 4'3-1- 312,$ <br /> PROPERTY OWNER INFQRMA�ION n �n �� m S�e a <br /> Name: b„ l Ksc <br /> Phone (day): 6\Z- - Mo• c11-33 <br /> I <br /> Address: 4175.1 fir. I %5-4--dl i'l City:k � e`17'�'s ZIP: 5-5-`10Email and/or Fax cYa.Q,1 4-ke,d e rre1 C)e_h u))• C.o;h , GL a e_e.ee-‘G . ate,5----•c& E <br /> ARCHITECT/ENGINEER INFORMATION --� rc�e'� - Cert <br /> Name: La e rvev) CA)ry oa..N LL C t. <br /> Z <br /> Phone (day): _ - - 4c- 9 l 1 1 1 J <br /> Address: l'400 C-,�.nv.� c")•-c- - City:R:ne,e c.S'cc� ZIP: 'C'S-540`-k <br /> Email and/or Fax: 01/4c-ok- Sin 0-441 , aeve Qr., 1Aw�tiQ . c,, . <br /> PROJECT INFORMATION: Description of project: _ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ew Construction Ingle Family with ;14. esidence <br /> ❑Addition attached garage ['Garage/Accessory Bldg. ADublic Sewer <br /> El Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public El Storage ❑ 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) ❑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) $ 00 000 <br />