Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS II-0/ <br /> �o A <br /> MailingAddress: <br /> Box 66: Permit number: cWf 7 O/2),-)--- <br /> V..0./Vo..‘ <br /> 1 <br /> 0 Crystal Bay, MN 55323-0066 Date received: /0—a-/—/T <br /> Street Address:' Received by: <br /> ti* 1t 2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> �"1kESHDl- 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. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: p �" + <br /> Job Site Address: la17 (U ► l.41►\uirS3' rcA, 1 Or>t"c MN' 5S 3 (Q'1-I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 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: r-tki Z0..b,\‘ c, <br /> State License# 61 A-, Expiration Date: <br /> Phone: (cell) 6 S() t 9 5— 2 c�1 (office) <br /> Mailing Address: 12A97 (A), (alv\ &r5A- Tri \ City: oro, ZIP: S '- <br /> S 3c, <br /> Contact Person: 4;1,kre,,., Za.L: ) Applicant is: Contractor /(omeowner� (Circle One) <br /> Email and/or Fax: 43 z A l t'1\ ,V1 s o LA ;ors , c 0Vv\ <br /> PROPERTY OWNER INFORMATION: <br /> Name: AA.01ttuo DI 11c, <br /> Phone (day): off U42) 303-01120 <br /> Address: 12(17 w. I d 1' ,,r51- `T-1,:1 City: O r-�r\o ZIP: 5 S 3 6y <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: Descri•tion of •ro•ect: e. oror Car ,w.--1-- <br /> 1.Type of Project 2. Proposed Use .Structure ype 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction 0 Single Family with 0 Residence <br /> ❑Addition attached garage 0 Garage/Accessory Bldg. 0 Public Sewer <br /> g.Accessory Building 0 Single Family with 0 Deck <br /> 0 Relocation detached garage 0 Office/Commercial 0 Private Sewer <br /> 0 Other: (specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> "Any earth movement may also require 0 Commercial E Other(specify) <br /> MCWD review&permits. 0 Industrial Tervyarw7 Car f"' 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 /> O1 <br /> Estimated Construction Valuation (excluding land) $ .� <br /> DE.�vIca — A/ o r At t5 <br /> Pi2w"cwe c9 ,v2 vem`46 <br /> .4)4, (cLtu ._ 1(- 10-Z.0141 <br />