Laserfiche WebLink
CITY OF ORONO 2'\ 'b <br /> BUILDING PERMIT APPLICATION (k .3-0'''' <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> 1.,jlic.AjoMailing Address: Permit number: #p�'O/2' Iff 3 bPO Box 66 ?,,Crystal Bay, MN 55323-0066 Date received: /./- �/7 <br /> , Street Address:' <br /> Received by: <br /> (: 2750 Kelley Parkway Plan review fee: AQ/7'-�LJr. 7 <br /> H���k Orono, MN 55356 0 /9/A7 , <br /> _ Main: 952-249-4600 Total Fee: 7I <br /> Fax: 952-249-4616 www.ci.orono.mn.us .0(a/ 7—e/53 I- / <br /> This application form must be completed in full and all required information must be submitted. lx <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z 2)CD (9t vi r 411 01-ov .3 , +Y/1 N SS3G 1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 2-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: 'Ptti Dm-K-5 <br /> State License # �L Expiration Date: rj//q <br /> Phone: (cell) 47,_?As - v6, (office) <br /> Mailing Address: 3 .d Vi �34J LA) KJ : 30Z Cit : L Ih, ZIP: g 41-7 <br /> Contact Person: !, Applicant is: ontrac • / Homeowner (circle One) <br /> Email and/or Fax: pgiL e PI11 ill IiutJ&5o7A _coA\ <br /> PROPERTY OWNER INFORMATIO : <br /> Name: '. av"I 1-‘')s,1-A PreAcv o f <br /> Phone (day): ( t2-$49- 11,7)"?, JP cell <br /> Address: 23`i0 C(i,ve - (-I'llt City: OYLv'-C ZIP: `JS 3'3k <br /> Email and/or Fax Mnje;ena-v0 6 S .Co A <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 /> Gil New Construction <br /> Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 13a Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ 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 0 Warehouse ❑ Private 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 /> Estimated Construction Valuation (excluding land) $ /� ' .) <br /> Last Updated: January 2016 <br />