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CITY OF ORONO
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<br /> BUILDING PERMIT APPLICATION �1
<br /> FOR NEW STRUCTURES OR ADDITIONS 10 4•KO
<br /> OAT Mailing Address: Permit number: 0 A
<br /> y�'O PO Box 66 �`-
<br /> Crystal Bay, MN 55323-0066 Date received: ,r
<br /> Street Address:'
<br /> Received by:
<br /> 2750
<br /> �� � 2750 Kelley Parkway Plan review fee: (3 7/,3 2--Jt�kESH���G Orono, MN 55356
<br /> Main: 952-249-4600 Total Fee: � ��� ac)-1C:>
<br /> Fax: 952-249-4616 www.ci.orono.mn.us ExroW Rn IALANWA4+,,, rri6lux6 Ye.3-
<br /> This application form must be completed in full and all required information mustbb submitted.
<br /> Incomplete applications will be returned. (Please print)
<br /> GENERAL INFORMATION:
<br /> Job Site Address: 7.17 00 k_z ?Z;,-..) - _.`‘ C
<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 servicei�411 Se
<br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:i
<br /> Name: C__.--,1C-\c,,J_� C._c. ,'r2<c-,a\-1c,.J
<br /> State License# •L,-k7 cY-.,S Expiration Date: :,13i t, ,(�
<br /> Phone: (cell) (eS\ _ - 9,..e,_- 9l3_ 3c..z.:--e_ (office) i..5\_3 - - .....L.,7__
<br /> Mailing Address: -7 L. { _e_,-„�,h.l, .k.b , Cit :-�..C(���,.yl.-t ZIP: �31, '
<br /> Contact Person: ..y^-) <'"1-y�� `N-- Applicant is: (ontractoi. / Homeowner (Circle One)
<br /> Email and/or Fax: f-5c : � ioc.e,; o,-,sw� N:,:,,,. , ,::-.,
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: kJ * A,->:14..-LA, \-\c, -.......--)
<br /> Phone (day): riST_- 72z-c.) t-i-`-c okk
<br /> Address: t`toi'S`'i /"u. ,..4‘.. Q,.,.i City: &IEA, ?r ZIP:` 5341
<br /> Email and/or Fax c,irw.e..\vat, 0 Y..s,,,V. C.:-c;e^-•••--
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Name: M-stL-i--_ Et1.,,,- (. ('_l-v- 6 _)
<br /> Phone (day): (1.:=.p.._- 7te - 7 1`'-Z-_
<br /> Address: City: r;r,,--i ZIP:
<br /> Email and/or Fax: ,,;IC.�l. 0 h f i✓\v- ,,,„C1;„.,,.,,,r,c@-P,:_,-y. c4,,,,
<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 /> Building ❑ Public Sewer
<br /> ❑ Accessory ❑ Single Family with 0Office/Commercial
<br /> ❑ Relocation detached garage 0 Residence (Private Sewer
<br /> ❑ Other: (specify) ❑ Multiple Family/Condo 0 Retaining Wali(s)
<br /> ❑ Public 4-feet or greater 0 Public Water
<br /> *"Any earth movement may also require 0 Commercial 0 Storage
<br /> MCWD review&permits. ❑ Industrial 0 Warehouse [g Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) 0 Other(specify)
<br /> 15320 Minnetonka Blvd
<br /> Minnetonka,MN 55345
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.orq
<br /> Estimated Construction Valuation (excluding land) BASO , 000
<br /> Last Updated: January 2015
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