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CITY OF ORONO <br /> ti BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��l V Mailing Address: Permit number: ZQ DO <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 1p Date received: 1 11 I 1 <br /> Street Address --4-6-11' <br /> - Received by: o- �� <br /> G` 2750 Kelley Parkway �6 t Plan review fee: <br /> I �Q �j <br /> �tgKISHO¢�c Orono, MN 55356 Cil 1 —00 / <br /> Main: 952-249-4600 — otal Fee: <br /> 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: <br /> Job Site Address: 2335 OIiver hill <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes N 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/APPLICANT INFORMATION: <br /> Name: YOUR) fie-id 14o -5 Act cocmifry Toe Nori.e-S <br /> State License# 13 C.v 2.7 6 70 Expiration Date: 3 - 3i - 17 <br /> Phone: (cell) q 52 - 3�O - 812.o (office) 952- /C 9 - yo 66 <br /> Mailing Address: 2Z_Co Dodd 6 j vd. Cit : Lr Ke-Vi t fe% ZIP: f$'o 1 <br /> Contact Person: Si-eve Sa k,i, j Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: SSG-LtI)er0 C_o(4-0,7-ry }Ce-Aecre,e-5„ Corn <br /> PROPERTY OWNER INFORMATION: ,/ <br /> Name: (AZEb crliNNIC lD ' Ftc.6ss►9-A/D.' r, <br /> Phone (day): 95Z. -2-,)--GIG, <br /> Address: Gr3?ro hi,0,96A, L•4/ EE G„xG,� City: %Zc '-fc/rev o ZIP: .Y9e1i3 <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: Fri 5 ('L fel I/ o <br /> kor <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> .New Construction r2 Single Family with 0 Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck [g Public Sewer <br /> ❑Accessory Building 0 Single Family with Office/Commercial <br /> ❑Relocation detached garage Residence 0 Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo ❑Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse I(Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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.org <br /> Estimated Construction Valuation (excluding land) $ 31( -7b <br /> I <br /> Last Updated: January 2016 <br />