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, <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,�O�O Mailing Address: Permit number: aG � -DQ�'q'g <br /> PO Box 66 , <br /> Crystal Bay, MN 55323-0066 Date received: �''j / <br /> StreetAddress:' __------- ��d.-k�---___l�-:V__._._.�_.. <br /> y�, G�' 2750 Kelley Parkw 2� �y���C� Plan review fee: b `� I O l(' <br /> t,�k�SHOR�, Orono, MN 55356 <br /> Total Fee: <br /> Main: 852-249-4600 Fax: 952-249-4616 www.ci.ocono.mn,us <br /> This application form must be campleted in#ull and all required information must be subrnitted. <br /> Incomplete applications wlit be returned. (Please print) <br /> GENERAL INFORMATIO � <br /> Job Site Address: � r �Gj,t,�,f�� Cy ��N � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or o er Disp y ome? Yes No <br /> If yes,a special e�rent permit is required witt►Poli�Department and City Council approva160 days pri r to the ev8nt. Shuttle bus servi 7 be <br /> requi�ed unfess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be aDowed. <br /> CONTRACTOR/APPLICANT INFORMATlO : L L <br /> Name: S%D� e W. � <br /> State License# Expiration Date: <br /> Phone: cell o�� <br /> Mailing Address: / t'D�: r'v G / Ci : � ,t� Z�p: " � Z> <br /> Contact Person: � Applicant is: antract r / Homeowner �ci�c�o�e� <br /> Email and/or Fax: i�^��y„� � S�o�,����,�, ��y, <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�"'�/,L,e ,•� <br /> Phone(day): <br /> Address: ��� City; Z�p• <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFOR TION: <br /> Name: „�r., /./��� • <br /> Phone(day): fl1 —���_ y�0 y' <br /> Address: / O / yr,� �i" L �t Ci : � �� ZIP: S )�?Zj <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.S�vage Disposal 8 <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 <br /> ❑Other: (speafy) �Multiple Family/Condo ❑Warehouse � Private Sewer <br /> ❑Public ❑Storage �i Public Water <br /> **Any earth movement may also require ❑Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCVYD) ❑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) $ � "�� <br />