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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> AZ ,� ' Mailing Address: 1d) Permit number: d of g- 004 7 <br /> 1*-ese <br /> / POBox66 7 t �-7 <br /> Crystal Bay, MN 55323-062 Date received: 1, / ZS <br /> Street Address:' 1, Received by: <br /> 2750 Kelley Parkway Plan review fee: 'i j 't24EsHo� Orono, MN 55356 do/8 boo 410, <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us � C f 40/ $.--0-0-0 t <br /> This application form must be completed in full and all required information must be submitted. ./ Q0-O �e(� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 232-0 ©f(Weir dill <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: f <br /> Name: YOQf�bc—13 I-tzwu3 DSA COUn G HzMi5 <br /> State License# F4(,2 07(? Expiration Date: 3-3/-1 <br /> Phone: (cell) aS — 380•— Olio (office) i5•„?. --/( / — 4"Ob& k /02- <br /> Mailing Address: 2_2_2_6,c) Ojai v0. City: L. ✓ .tI <br /> r iP: 5'Sncry <br /> Contact Person: = c'� Applicant is: ontrac ori/ Homeowner (Circle One) <br /> Email and/or Fax: s$cc..b-er C��titin j jcehoMerS an'l <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <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 /> Water Supply <br /> ` New Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck Cgf Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Office/Commercial <br /> ❑ Relocation detached garage Residence ❑ Private Sewer <br /> ❑ Other:(specify) 0 Multiple Family/Condo LI Retaining Wall(s) <br /> 0 Public 4-feet or greater ❑ Public Water <br /> ""Any earth movement may also require 0 Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse XPrivate Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) $ 35-1160k RECEIVED <br /> JAN 1 7 acid <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />