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v <br /> CITY OF ORONO l <br /> BUILDING PERMIT APPLICATION / / 59 9Z <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> f <br /> O A, Mailing Address: Permit number: /3O/e��9 <br /> / `VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: .3 -3C-!g <br /> Street Address: ./ <br /> :e: ee: <br /> F c. 2750 Kelley Parkway 7a/, i —5 <br /> t�kESH43�'� Orono, MN 55356 �� 0D1 <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: J <br /> Job Site Address: -� '5� /n v�' 14-) L irde 0 r 1,1 c /19h <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes El 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: —�7—' <br /> Name: / n-t L7r/7-thee <br /> State License# Expiration Date: <br /> Phone: (cell) 773-233 2S/ (office) 763- 7y y-SR-5z <br /> Mailing Address: 22,57, Z.7-Vvf -' Ci-cue Cit : Oroh a ZIP: <br /> Contact Person: —7i�,., Gp' -hc/ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: 6,.///,,e,741crw,4//, cow, <br /> PROPERTY OWNER INFORMATION: c/ <br /> Name: %i i-n Gr12h er <br /> Phone(day): 76'3 - 233-2G5/ <br /> Address: u Se 1./-4.) C.OviAe City: Orate o ZIP: <br /> Email and/or Fax G'ei'ddyie r ' A.-,a//. cd.-,-, <br /> ARCHITECT/ENGINEER INFORMATION: n / <br /> Name: C'tia.c� 5 ��s Care- /Je si , /&i/o L/C <br /> Phone(day): G 62 - .1d9- „<-7.f4/ <br /> Address: ' 4o r /4/"'K .'e STICity: /4/c ZIP: ...5--5-V/7 <br /> Email and/or Fax: �ti w 10 _ Core e,Silk) buil of , het- <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 /> ❑ Public Sewer <br /> El Accessory Building CI Single Family with ❑ Office/Commercial <br /> [' Relocation detached garage gj Residence IN 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 ❑Warehouse <br /> IZI 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.orq RECEIVED <br /> 0 <br /> Estimated Construction Valuation (excluding land) /06 "CO , °' <br /> MAR 3 0 2018 <br /> Last Updated: January 2016 CITY OF ORONO <br />