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. , <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number. ZO��/�' (�I Z <br /> g- �� PO Box 66 <br /> Crystai Bay, MN 55323-0066 Date received: Z �Z <br /> StreetAddress:' Received by: � <br /> y� ��'" 2750 Kelley Park ay P d� 21(P� Plan review fee: � <br /> �,G Orono, MN 5535 � <br /> �'�xESHOR o a . <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. (Ple e print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: �Cl/�C,�S��� �C �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display H me? es ❑ No <br /> /f yes,a special event permit is required with Police Department and City Counci!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-permrtted events will not be allowed. <br /> CONTRACTOR/APp�-IC�'���"�A TI��� <br /> Name: a-'�- t 4���- • � <br /> State License# ^ C� Expiration Date: l <br /> Phone: cell -3 _ Q� office S -� $- � 5 <br /> Mailing Address: � � �' �.� i I�d- � l�l Cit : n CtZIP: �jS <br /> Contact Person: —� C � Apply'cant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: j�l.t� [� c.�; (d� o <br /> PROPERTY OWNER INFOR 10 : � <br /> Name: �c�c a � ��t � � �, <br /> Phone (day): 5�- � — U� - ;,� 1 �j -�—� `� <br /> Address: 1 —" � " � l 1��- Cit : 'VY�,r,� ,�, ZIP: �> > �`[� <br /> Email and/or Fax � [� L ��•^Uvc ct -Nr� r` <br /> ARCHITECT/ENGINE INFORMATION: <br /> Name: 0.�-J 't.11/fLk� <br /> Phone (day): - 5- U �-{ <br /> Address: (I� �L ✓� Cit : , ZIP: �� 3�� <br /> Email and/or Fax. ' �,UUc� a � Ic e , oYh <br /> PROJECT INFORMATION: Description of project: <br /> 1.Ty e 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 aiso 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 /> wv�nv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ,3-S o� � � . <br />