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� <br /> • � , <br /> _ . CITY OF ORONO / I���� <br /> � BUILDING PERMIT APPLICATION �,�I`� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: o?D(7 — O/ �O <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: I�8 � 7 <br /> Street Address:' Received by: o?p —!>! " <br /> � �' 2750 Kelle Parkwa <br /> y�, � Y Y Plan review ee: � <br /> G Orono, MN 55356 <br /> j'x�sHo�� - a�5�.Ot� <br /> otal ee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 17—Ol��i <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: �Q�Q �/��ll/✓� �d�/l� <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 Deparfinent and City Council approva/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: Ndr-}-T)r1 �}'vn-1-LS,� L L c. <br /> State License# f�(� (o,�aa—1 Expiration Date: 3-3l-/9 <br /> Phone: (cell)(o(�-�$�p-?lQ(o/ (office) �1P3•SS9'�99/ _ <br /> Mailing Address: �'�► t N • !� Cit : d ZIP: S �/�/ <br /> Contact Person: r Applicant is: rac o / Homeowner (Circle One) <br /> Email and/or Fax: � e 0 C <br /> PROPERTY OWNER INFORMATION: <br /> Name: 5o�ce (�►-trl (�'ei/e%m�� <br /> Phone(day): 7fi -$'S/�di� <br /> Address: ��a�-l.� �l �"'/�I�G N� S�'C. ,Q City: ��[alYl�l� ZIP: ,Ss�/�( <br /> Email and/or Fax �j'IZ. Sd�/r2� [cirl,c(. c'o,.,,� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: grl/GL (,-Gl�t,r�r- <br /> Phone(day): 7(03• S�S• �/'�G <br /> Address: �a, c. N Cit : G' � ZI P: "��S�a" <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of ro�ect: N /�iGS/��1.�1a� c�lu'] <br /> 1.T e of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> �/ Water Supply <br /> New Construction LJ Single Family with �esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial �rivate 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&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) $ �JU/ UUv <br />