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. � 5 ��-�� �� <br /> �}������ CITY OF ORONO � D' <br /> �,� 1� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: Q� � vv <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7'"�—/ <br /> StreetAddress:' Received by: � _ <br /> � ` 2750 Kelley Parkway Plan review fee: �J�. (� <br /> `� � � Orono, MN 55356 O!3�� � ry <br /> � <br /> A'rESH� Total Fee: �\- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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: �f � � <br /> Will this be a Parade of Homes, Remo lers 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 service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAT ON:/ <br /> Name: ��.��. �,,-� �.���.r�1�i� 1,F� <br /> State License# �`;C S"9�t2�� Expiration Date: ��-�I-/� <br /> Phone: (cell) �',�� _�Lrj.,�73� (office) <br /> Mailing Address: _„� Cit :� ZIP: �; <br /> Contact Person: A plicant is: ont / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �..�sa�;C�� � � <br /> Phone(day): <�5� - ��� -oiy� <br /> Address: �S�r, ;�'raC .� -�..��n CitY� ��f�,�L� ZIP: �i'��'� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed 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&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 /> $ � i- <br /> Estimated Construction Valuation (excluding land) �L�� <br />