Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ap <br /> �O • O Mailing Address: Permit number: � �� � <br /> n� PO Box 66 <br /> ystal Bay, MN 55323-0066 Date received: Z I � I� <br /> �'t � Address:. ^�_...._._R�jv_ed by-__ __ � ►� <br /> __ <br /> ----�. <br /> _ ---- - <br /> � � � __ <br /> s' � w rA� 275 'L(7(�-�,�U� � � Plan review fee: '` �� � <br /> F! �' ..!►rV�'�� ono, MN 55356 ___—____.— .._- <br /> �KFSH��� }� Total Fee: <br /> Main: 952-245s480 x: 952-249-4616 www.ci.orono.mn.us (,'��/ <br /> This application form must be completed in full and all required information m,4rst be subm'�t�d. �� �,/ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� �/QV�S� �j(,{��u � �P� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ❑ No <br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wi//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: l��c�l�J'l. ���`P �01�1�1'���2-.S �/?L <br /> State License# l� (�� 7(p Expiration Date: <br /> Phone: cell �� aSl.� -,��SZ� office <br /> Mailing Address: � 11�01C, �U Cit � � e. ZIP: a� <br /> Contact Person: i �'!� Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: 1fY1� � 1�1�, l � c�Z , 'pj'i' <br /> PROPERTY OWNER INFORMATION: �"� „' <br /> Name: i'�J� � UU'11'll�l�- ��A.�UI� <br /> Phone (day): " � <br /> Address: C 1^ Y-P�✓ C �'►'� Cit : �1)n O ZI P: ��D4 <br /> Email and/or Fax ?."PZ. �1 'f'h <br /> ARCHITECT/ ENGINEER INFORMATION: ` <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of ro'ect: <br /> 1.Type of Project rt' 2. oposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction Single Family with Residence <br /> �Addition attached garage Garage/Accessory Bldg. ❑Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �� � l.� �� <br />