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. CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: ZdC � <br /> f Vo PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � -� �Cj — 1 <br /> � Received by: <br /> .� �, StreetAddress:' ._--�- — - ----- ._-- -- — _____------------ <br /> - . __-- <br /> S'�. G: 2750 Kelley Parkw y ��( �p—�� Plan review fee: u'� � '�� <br /> (�k£SH��� Orono, MN 55356 �__ 3 _- ----_- __ <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: <br /> Job Site Address: ► - 75 (���(e �d;Je, (��oy�c , M�;' �s�(G� <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 requi�ed 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: Hav�S� �"lvwre�ec�, lhc, <br /> State License# gG �/ZG I Expiration Date: <br /> Phone: cell (�Z- � h-i y�b office �SZ �13 y 0�Sy <br /> Mailing Address: 7y2.d KG�`b�� �(v. City: G�„��l��s��H� M ZIP• S53/7 <br /> Contact Person: (ru✓� yU � � Applicant is: ontrac / Homeowner (Clrcle One) <br /> Email and/or Fax: ��y(i�h,�y�(�aehef"� �Co:+� <br /> PROPERTY OWNER INFORMATION: <br /> Name: Lc���y Gc�,� <br /> Phone(day): <br /> Address: City: ZIP• <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��/c, <br /> Phone (day): <br /> Address: Cit : 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 /> ❑ New Construction Water Supply <br /> � Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> ❑ Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation ` detached garage � Residence ❑ Private Sewer <br /> �Other. (specify) �n-��of �8n'�od�, ❑ 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 8�permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eci ❑ Private Well <br /> 15320 Minnetonka Blvd � p �� ❑ Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �vww.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 13G� �(�Q <br /> � � <br /> Last Updated: January 2016 <br />