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CITY OF ORONO �y <br /> BUILDING PERMIT APPLICATION ��� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailrng Address: Permit number. �C'��l ��� � ^ L <br /> PO Box 66 <br /> � �� Crystal Bay, MN 55323-0066 Date received: Z �LZ <br /> StreetAddress:' -- Received by: � L--� <br /> y � 2750 Kelley Park ay � v U � � <br /> �d � f tP� Plan review fee: <br /> `�{ �,G Orono, MN 55358 � L;__�.� _ <br /> '9�ESH�R � � <br /> oa . -7 � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �,} L / . �' � <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: � • _ B " � � � <br /> Job Site Address: �G�%t 5���� tt1v� �� <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display H me? [�"Yes ❑ No <br /> If yes,a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be <br /> reguired unless applrcant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP�-IC "�T'"' ��p A TI � <br /> Name: ��C'9c�Gl 1'� i��C���- � �:.-- <br /> State License# (� Expiration Date: ! <br /> Phone: cell -3 � office S -� �- 5 <br /> Mailing Address: ► � �� i V-L u ��1 Cit : �n. C�ZIP: � <br /> Contact Person: —f c , ' Appl'ycant is: ontractor Homeowner (Circle One) <br /> Emailand/orFax: -- a u� Idfe � <br /> PROPERTY OWNER INFOR 10 : � <br /> Name: �c�c cl � ��lt � Q,.S � c <br /> Phone (day): S� " 5— U� -� .� 1 U� <br /> Address: ( — � ��� I V� Cit : YY�,�,� �,�. ZIP: ���� <br /> Email and/or Fax ....�� �, li �U�X�c a � <br /> ARCHITECT/ENGINE INFORMATION: p <br /> Name: �I�Q-�-I--,.� l�li�(��U�.. <br /> Phone (day): ' - 5� C% `-1 <br /> Address: (I-7 ' c,�� c.t�� �✓� Cit : � ZIP: S� 3�f� <br /> Email and/or Fax: ' LUUc�� a � Ic e , � <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 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 /> wwvd.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ,3-5 Q� � � • <br />