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CITY OF ORONO i 9 5 . <br /> BUILDING PERIVIIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: �,/4,a/ii <br /> "e-1:5.0. , <br /> Permit number oc /l/PO Box 66 <br /> Crystal Bay, MN 55323-0066 pa-,/ Date received: /,2--/ 7 <br /> �" .`4 Received by f0�Street Address:' Q��j2750 Kelley Parkway C _`i\V Plan review fee: $,3,25, ?2 <br /> ,,,,t <br /> Orono,MN 55356 N _ 0/y <br /> al� o 3 <br /> Main: 952-249-4600 Total Fee <br /> Fax: 952-249-4616 www_ci.orano.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: 17c ' /01. r-c5 8 'yt{-- <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: S><O,nCWOC L LG /5,-' d' )/7 -7'1- <br /> State License# C?-/31.5-- Expiration Date: <br /> Phone: (cell) q.sa-zq2--6,630 (office) /y. 162 -<-0e1D <br /> Mailing Address: ,S la . Sir - Cit : ''"'"" �. ZIP: S`S37 <br /> Contact Person: ;l _ i '-' <br /> ..Applicant is: cContrac or / Homeowner (circle one) <br /> Email and/or Fax: �� ��,5 , a-rice Cdbvt.- <br /> PROPERTY OWNS INFOATION: <br /> Name: Keir RMsr � <br /> Phone (day): 681 _j 3 - 3e/0 <br /> Address: 2a f,4",1nnPpi K. A.did, r �DCity: pip/6 ZIP: S may© <br /> Email and/or Fax - - - a ,a _ 5-4-4242,9—.. <br /> ARCHITECT/ENGINEER INFORMATION: 7n f' '�i � fu►� • <br /> Name: 1 <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 /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Familywith aPublic Sewer <br /> 9 ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> vg Other: (specify) `a.6-e-' 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 ❑ Storage <br /> MCWD review&permits. 0 Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) 0 Private Well <br /> 15320 Minnetonka Blvd Other ��Cifi�') Q Otherpity) <br /> Minnetonka,MN 55345 IR <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> .o.v;y.minrohahacreek mg <br /> Estimated Construction Valuation (excluding land) $ v30/. ° - 4— 11000wail <br /> Last Updated: January 2016 <br />