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e CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS V.,*,„,.. Mailing Address: Permit number. �6 I - COAL- PO Box 66 Crystal Bey,MN 55323-0066 Date received: ( c'/ to Street Address:' Received by: JO fppSH �.1. Oron0o,MN 5535 Park y9 01(o-oU5 -Ia review fee: 5_, �% S) Main: 952-249.4800 A. Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: / go a FOrvc I,ANT_ Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? II Yes iI No If yes,a special event penn/i Is required with Police Department and City Council approval 60 days pax to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking Is available. Non permitted events wilt not be allowed CONTRACTOR/APPLICANT INFORMATION: Name: S-f-aue-v-aois Lr_L State License# ac,c44-316-- Expiration Date: _ =31.'5//2c-Le Phone: (cell) All ;IS i' `f-°i (office) 6 I-t-- 44'z.-4000 Mailing Address: I53 r- !.A rr-V ..i . City: in,r,- e r,4- ZiP: 571 r Contact Person: c V E tJ 4-1/41 lkP;o J Applicant is: Cotractyr I Homeowner (Circle One) Email and/or Fax: Svi!r,e c{-cyvt.,wAo c-Pv+f^-s. PROPERTY OWNER INFORMATION: Name: ..r NI t _ _ " EV a CA'k LE- sr" Phone(day): 612-R51-34 t e) Address: 30153 CAi'Koxi Ave3 City: M)tiide L11 ZIP: T 4og Email and/or Fax i....ge LT-.,1 c v-6) 4 IN At L ein..� ARCHiTECT/ENGINEER INFORMATION: Name: lVn.td4../ Rctlne, 41- i7Cs1&,41. .L,uc.. IAip pLANr✓1ti.6. ' Pe-sikA/ Phone(day): b3-;tom- Bio 4- Address: 6/60 &alh,.,o t 51;• /VC (rd__ City:,R.,,-m./e" ZIP: cc 4-4-/ Email and/or Fax: ii,i,p eg f des+9n•cawe PROJECT INFORMATION: Description of project: A,�Q c., j ± ( 5 __ 1.Type of Project 2,Proposed Use 3.Structure Type 4.Sewage Disposal& gi Water Supply New Construction (f]Single Family with ❑Accessory Bldg.I Garage Addition attached garage ❑Deck W Public Sewer Q Accessory Building 0 Single Family with 0 Office/Commercial Relocation0 detached garage 41 Residence ❑Other(specify) ❑Multiple Family I Condo ❑Retaining Walls) ❑Private Sewer ,R 0 Public 4-feet or greater 0 Public Water Any earth movement may also require 0 Ctlmrnerciai 0 Storage MCWD review&permits. 0 Industrial 0 Warehouse IZI Private Well Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) 0 Other(specify) 16320 Minnetonka Blvd Minnetonka,MN 55346 Phone: 952-471-0590 Fax: 952-471-0882 �www.rgjnQshecreek.orcL_ Estimated Construction Valuation(excluding land) $ I / 17 7 I o a' Last Updated: January2016