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.. <br /> CITY OF ORONO <br /> , 4 S7 <br /> F. 74. (7 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> 'L.O,� } Mailing Address: Permit number: AO/g- //i/ <br /> 0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 3 -/- 1 <br /> Street Address:' Received by: ��4 <br /> 'YS4. 2750 Kelley Parkway Plan review fee: '�y 5) 3• <br /> C•gk�SH��4C' Orono, MN 55356 0?0 / UU j f,L <br /> Main: 952-249-4600 Tptal Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us C yd 4 pA,50D. OD _rt. <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: 2.330 O l i Ve-r Hi/I <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: <br /> Name: YOvl�b�l640 i-fr t3 ©8A Co iri d C ( bwu 5 <br /> State License# '46.7(070 Expiration Date: 3-3/—iq <br /> Phone: (cell) (15;9. - 3E0 SIZO (office) G15?► -10q - 4"Ob& k /02- <br /> Mailing Address: 27 g_6,t, ' Oji) 13�..A)0. City: Vr (..-i:4251- P: �',S©cyr f <br /> Contact Person: — c� Applicant is: ontrac or +/ Homeowner (Circle One) <br /> Email and/or Fax: 55 b-er- . )[d;,o,ti}y jo—e h o/VeS ; Co lr► <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: Frt,'dzol $&t (e-- fa";i7 l,,e►•te.._ <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 NI Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage z Residence <br /> 0 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 XPrivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 0 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 /> RECEIVED <br /> Estimated Construction Valuation (excluding land) 368, 0 5( <br /> FEB U i Z018 <br /> Last Updated: January 2016 CIN OF ORONO <br />