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M � ♦ 1 � <br /> V ,(,/� <br /> . ��"� <br /> � � � CITY OF ORONO � � �,�5, 50 <br /> BUILDING PERMIT APPLICATIO <br /> FOR NEW STRUCTURES OR ADDITI <br /> �O� MailingAddress: Permitnumber: O�d � —� � <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —�—� <br /> StreetAddress:' Received by: 7 <br /> � G� 2750 Kelley Parkway Plan review fee:� ���. � <br /> `� ¢ Orono, MN 55356 a���_d--�� <br /> l�kESH� � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � Q,�`(�/ <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: /����/p j�izs� L��,,,,�c�:ncLi2 <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. 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: .Sy�i /�/��S' C��vs�,�� <br /> State License# i���� Expiration Date: 3T��T i�, <br /> Phone: (cell) ��� -y/�-_ 7� 2 (office)9s�z -yy� �-is`72 �� <br /> Mailing Address: " Cit : iil — ,✓ ZIP: - - <br /> Contact Person: _�°���vr� �,�,' c Applicant is: Contrac o / Homeowner (Circle One) <br /> Email and/or Fax: c,�'17i;v L.�`�r,2�,,,i,;« ,�„�T. ,.�„i i <br /> PROPERTY OWNER INFORMATION: <br /> Name: _Z�`c %�r,1�c% <br /> Phone (day): P.,S"/ � �1 i y - '3 9 /. � <br /> Address: /�yD f��ZsT i�����T ����cL�� City:�fZC'I,rlp ZIP: �j��j(/�-' <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: !i>�; �/"' v��� , k���/�/LG�� <br /> Phone (day): (�f-�.. ��� 2�p/ <br /> Address: /� �z. /lit.�i sil�:7;e � rz�viL City:/�'S�j�,��tli/�iJ ZIP: �f d -�f <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> �� Water Supply <br /> ❑ New Construction L�?"Single Family with �Residence —/ <br /> j�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) �, ther: (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) $ /c�S� ��1� Or U� <br /> ,� <br /> ,i <br />