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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: cab 7 j-O l`. 4-,=VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: / )— - <br /> Street Address:' Received by: R P <br /> y� 2750 Kelley Parkway Plan review fee: ���• c 3 <br /> l44-EsH0°. Orono, MN 55356 e.. t S -o $S <br /> Main: 952-249-4600 Total Fee: / 0 7j, . /2- <br /> Fax: <br /> Fax: 952-249-4616 www.ci.orono.mn.us LCi fy rurn411�- mum( >r <br /> This application form must be completed in full and all required information must submitted. p p(v <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: _ L--n--,G9 �Z%zi/is <br /> Job Site Address: 2 40 g 7 // 11- -/ k ,- -_ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes E 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 IN I ORMATIOW.)�l J 4 v p <br /> Name: 4,)arwJ, err r (` <br /> State License# Co S/l Lf‘--- Expiration Date: 2 0 / (p <br /> Phone: (cell) (y I Z 2.Sv —7/ t6 0, (office) e1 Ca ''7`>< �`,, , <br /> Mailing Address: 's N'Fe t,_ City: o-��e� ZIP: ---S-3 3 <br /> Contact Person: -Q F I= Applicant is: - •ntrac • / omeowner (Circle One) <br /> Email and/or Fax: — _\-e Pt- -'aK cf`N y w .a i I • CU-.t <br /> PROPERTY OWNER INFOR TION: <br /> Name: ,4-et...__ , l <br /> Phone (day): Lel Z. - q 7 ir- L4—If <br /> Address: ZCe 7 7 L JI--e /,'`''e--- City: c' nen--10 ZIP: 13- --S t / <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: ''" e0 _ <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> El New ConstructionWater Supply <br /> ['Single Family with 0 Accessory Bldg./Garage <br /> a-Addition attached garage 0 Deck <br /> [ Public Sewer <br /> Accessory Building 0 Single Familywith 0 Office/Commercial <br /> ❑ Relocation detached garage 9'Kesidence ❑ Private Sewer <br /> ❑ Other: (specify) 0 Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater E Public Water <br /> "Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse <br /> 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 15320 Minnetonka Blvd ( p �) 1=I Other(specify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> yG <br /> Estimated Construction Valuation (excluding land) $ IC/ oo 2 <br /> Last Updated: January 2015 <br />