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CITY OF ORONO <br /> BUILDING 1�ERMiT APPLICATION <br /> FOR NEV11 Sl"RUCTUR�� OR ADD(TIONS <br /> Maifing Address: {Permit number" ��.� � <br /> ��L�.�j PO Box 66 <br /> ��• Crystal Bay, MN 55323-0066 ;Dafe received. --3.��� <br /> StreefAddress:' �Receivedb: ��� <br /> �;. �. , -,�� . 2750 Kelley Farkw ?p��'(�ZSS��Pf`."' rfee: � g� �� <br /> . �`'r. ?• ' �.•. ,�G� Orono, MN 55356 ...'. <br /> �, �'.:'".' � <br /> "�tiEsFio �T,otal Fee:. D <br /> Main: 952-249-4600 - Fax: 952-249-4616 www.ci.orono.mn.us �;;;;.;::.;'; <br /> Ttiis appiication:fo�m must.be�completed=.in•;full;'and:ail require'`d?irifo.rmation:must'be�'subrtiitted: <br /> Incomplete appli�cations+will`be returned: (Plea�se print) <br /> GENER� INFORMATION: ���� <br /> Job Site ddress: W <br /> Wiii this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes o <br /> !f yes,a specia!event permit is required with Police Deparfment and City Council approva/60 days prior to the event. Shuftle bus service will be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events wlll not be allowed. <br /> CONTRACTOR/APPLICAN R TION: =a C <br /> Name: <br /> State License# Expiration Date: <br /> Phone: cell • • office • � • <br /> Mailing Address: ` Cit : '' ` P: <br /> Contact Person: ` W:'� ppficant is: ontrac o / Homeowner (CircleOne) <br /> Email and/or Fax: <br /> � � I <br /> PROPERTY OWNER INFORMATI N: <br /> Name: � <br /> Phone(day): � ' • � " <br /> Address: Cit : �VJ IA ZIP: � � <br /> Email and/or Fax ' �� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: !' - --- 'r iArS �w f V1�k GI��. <br /> Phone(day): � <br /> Address: CitV: Z�P: <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.Sewage Disposal& <br /> Water Supply <br /> ew Construction ❑ Single Family with esidence �,/ <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation �,rdetached garage ❑Office/Commercial ❑Private Sewer <br /> ❑ Other:(specify) B�Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage Public Water <br /> °rHfly�£3C�Y1 lI10Ne1]1211Y IY13u aI50 fLOUifB ❑ Commarcial ❑ 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.minnehahac eek or <br /> Estimated Construction Valuation (excluding land) <br /> � ,�� ���— <br /> 3 3Z�' � <br /> �� � <br />