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. <br /> S <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number. ��� `� '�6/ y( <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � Z-I Z Z�� <br /> L-(� <br /> � Street Address:' <br /> y� 1�'' 2750 Kelley Par ay �''� ��(p� n review fee: / l . � <br /> �"�x'ESHo��� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be complefed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ��j� (� �_ ^�S�. JE �,�.�- ���� <br /> Job Site Address: � �7 `�.�'r� �`� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> /f yes,a specia/event permit is required with Police Department and City Council approva160 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 INFOR ION�. 1 � <br /> Name: Q.,�t'_ t�f �Gt�.� C� <br /> State License# Expiration Date: ( c'�CJ/ <br /> Phone: cell 3— 3 .3 - �'t8 office � -3 S' � <br /> Mailing Address: f E r-.(Cr� . Y� c.,�, Ci : �_ ZIP: SZj � <br /> Contact Person: �� S'c. vJ,.e- Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: — .�. tU�d . 4. �. t.t.t ��.(> i <br /> PROPERTY OWNER INFOR A 10 . < n <br /> Name: (�-i �G�P�IZS � <br /> Phone(day): `a-- �(S - P�S 3 _ �`-�-� jC)1 (� �f <br /> Address: ` f Cit : ��n nQ"�U��dL ZIP: �� `� <br /> Email and/or Fax -���C� � a Q- �c.lc ( �Q. , <br /> ARCHITECT/ ENGINEER INFORMATION: p <br /> Name: "� LL ir�-.l.t.d`-- <br /> Phone (day): �� -3 j''_ C', l�/ ` �.�J7� <br /> Address: "i,i,�% - .L-% ��r/',�- �`� Ci : �l rY1r� IP: <br /> Email and/or Fax: �'y� � vcxQ �2 <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Struct re Type 4.Sewage Disposal 8� <br /> Wate Supply <br /> New Construction ingle 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 8�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 /> Estimated Construction Valuation (excluding land) � ������ <br />