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' G�'" �.11 <br /> CITY OF ORONO Q,+M���-� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ���� � t�+--'�Q� <br /> �O� � Mailing Address: _ _ Permit number: � � �� <br /> PO Box 66 _��,/ <br /> � � �,f Date received: <br /> C �l Crystal Bay, MN"5532 -0066 / �� <br /> � � pj Received by: � �� <br /> � � Sfreet Address��' �� <br /> 2��, � � �{�J 2750 Kellej7,Parkway � � Plan reviewfee: �� <br /> � �' � Orono, MN 5�b6 ) Q� �f p <br /> �kESH��� � Main: 952-249-4600 <br /> 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: I�-{ ( -�j (�/� (� �C— �/LL`0�� Q2p.1/J M� �5,3� � <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 approva160 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: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ►3 rt r� P��z�. r-lv�r <br /> Phone(day): �i a - (� y �-1 - (Q U S f <br /> Address: — /}� � ��2. Cit : rc u-,,/p ZIP: �5�lv <br /> Email and/or Fax t,,. �,.i e �c� ��-r�� , t�.,-..t, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: n��r�� �l s�-�r 2.r ~ v u T-,vvoVc �'x ��-,��1 <br /> Phone (day): ies-1-SO 3-G 5 FS 5" <br /> Address: a 3�l,�" ipr�yt/s'��..� �T City: L�-,�/� C�t ZIP: S-�� <br /> Email and/or Fax: ,.�,, I�w,,� {; � o w �a�oor ekc �,ats, � v�-•1 <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 ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> �Other:(specify) 17 L�G 1�. ❑ 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 � Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (specify) ❑Other(SpeCify) <br /> 15320 Minnetonka Blvd �C5 n'Jtrr✓Tctr�- <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 ���'� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ '$Oi CJ U O.0 0 <br /> Last Updated: January 2016 <br />