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1 . <br /> CITY OF ORONO �f , �� <br /> BUILDING PERMIT APPLICATION i `3�3 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A,O Mailing Address: Permit number: l���, -- <br /> `V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 1 -� �Cj — I <br /> � ,, Street Address.�� Received by: � <br /> _ � <br /> y�. � 2750 Kelley Parkw y � {,�CL�`�` Plan review fee: `� � ��' � <br /> !�'�ESH���G Orono, MN 55356 �'� � `��C����___ ' <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 subm' d. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ' �JS ('c.`'�� ��-v'�, U�;�.���c �1"�' S'Sj(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 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: i-'u��S�vr �������rc� �hi� <br /> State License# �C (�(l�/ZG f Expiration Date: <br /> Phone: (cell) �l Z - �'C���y�b� (office) �'1 SZ y 3 y 0�S�/ <br /> Mailing Address: 7yZ0 K����'� �(u�. City: C�,�-,�l�a6Sz�f M,ti` ZIP: �53/7 <br /> Contact Person: Cyu✓� f-la j,� (� ;�. Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: _ ,;,c���yC �,U�,��(��t.h�� :�p;� <br /> PROPERTY OWNER INFORMATION: <br /> Name: Lc�J���y G-c�, � <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ,�/�, <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 ❑ Public Sewer <br /> ❑Accessory Buitding ❑ Single Family with ❑ O�ce/Commercial <br /> ❑ Relocation detached garage � Residence ❑ Private Sewer <br /> �Other: (specify) �h+Gr�`of ��r�o��� ❑ 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 /> ❑ 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 /> •,�rnv.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 13C�, (,�(�C <br /> Last Updated: January 2016 <br />