Laserfiche WebLink
CITY OF ORONO �� <br /> BUILDING PERMIT APPLICATION 5`� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> . o A' Mailing Address: c/s-00 3 <br /> <V PO Box 66 Permit number: -J <br /> 0 Crystal Bay, MN 55323-0066 / Date received: �-j <br /> Street Address:' \ �� Received by: 43.. riA. . <br /> ti� G� 2750 Kelley Parkway V�\� Plan review fee: /'/. ° <br /> t Orono, MN 55356 <br /> 4KFsH°V.� 02015 —e,-0,3?- —. <br /> Total Fee: <br /> Main: 952-249-4600 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. ectvidl ettivoU <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 60 0 co n o p,,-ckq,,-e.,l g S <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 INFORMATION: <br /> Name: 1:)«K5 kn1rr,r-1-.ecA <br /> State License# t3c b a,iSr Expiration Date: 3— 3/- /7 <br /> Phone: (cell) (D I o1- ?v., -680a. (office) <br /> Mailing Address: 5-7o 3e-o4 sir' - City: okga—d ZIP: '"'`-i S-5-'3a 1 <br /> Contact Person: Rq„q y fvto-L. Applicant is: ontrac or / Homeowner (circle One) <br /> Email and/or Fax: 1Moe rgnot y 0 y=hoo . c u.v.. <br /> PROPERTY OWNER INFORMATION: <br /> Name: Doo W h ;+c 1-e.,%-/ <br /> Phone(day): °t 5?- a I o - -7333 <br /> Address: City: ZIP: <br /> Email and/or Fax <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 /> New Constructionngle Family with ❑ Residence <br /> Addition attached garage ❑Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building 0 Single Family with ,g Deck <br /> ❑ Relocation detached garage 0 Office/Commercial 0 Private Sewer <br /> ❑ Other: (specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> $ / )' r S <br /> Estimated Construction Valuation (excluding land) � <br />