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CITY OF ORONOll 1• &� <br /> �� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> -VI MailingAddress: Q�Q/7-GYJ(p�/p9— <br /> Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: k.-. .2.--/ 7 <br /> Street Address:' Received by: ,v .F " ip <br /> 1. G` 2750 Kelley Parkway Plan review fee: #,I 745. k0 <br /> ��110ESH0�� Orono, MN 55356 a0//7_ pZ2(9 <br /> Main: 952-249-4600 Total 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: ZI 7(-I-S Q(A Vl_(2- /41'0.- <br /> Will <br /> 4)(,l,,Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YesNo <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: i <br /> Name: Yt r�,6c Hv AL3 D8A CO ir' j di:-C- 1-6465 <br /> State License# 3602 (©7O? Expiration Date: 3-3/-/ <br /> Phone: (cell) qct -38O Sii2o (office) '15?' -'146/ - gob& j( •/O2_ <br /> Mailing Address: 2-2.y 690 t}j>i) 13 J0, City: 1‘,4„1-7‘.6 i..-c-al P: 515-pceeJd <br /> Contact Person: - t - Applicant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: $$ b-e,r Cod.4,1-yi ,CO,rY► <br /> PROPERTY OWNER INF9RMATION d I / <br /> Name: erri q a.., rT b-r' T <br /> Phone <br /> -400— , �j� (-Ake- Sc3Sc <br /> Address: V 6 7 k/a_ .(AAA j • City: 9 ZIP: <br /> Email and/or Fax keir-ei .j. 1 L ® y r/. COwj <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 /> IN/New Construction IgiSingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck Cgi Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage Residence ❑ Private Sewer <br /> ❑Other:(specify) ___ ❑ Multiple Family/Condo K 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 [Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ 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.or4 <br /> Estimated Construction Valuation (excluding land) $ 3't7 10.— ---- RECEIVED <br /> JUN 2 2 2017 <br /> Last Updated: January 2016 CITY OF ORONO <br />