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� ' - �iTY OF ORONO Cv."�js <br /> � �2 , <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number . > ��'�� .(j{�Z�'. <br /> g.OlU PO Box 66 <br /> °0' Crystal Bay, MN 55323-0066 ?�Date received: <br /> StreetAddress:' ?'ReceiVed by: <br /> y� ;� 2750 Kelley Parkway � ri� ,.� >Plan:review fee: `* ,� 'ZD �/-DOZ� <br /> �` Orono, MN 55356 '^ � � � <br /> `�K�SH��� >?Total Fee: <br /> Main: 952-249-4600 = Fax: 952-249-4616 www.ci.orono.mn.us 5�,;;,;: <br /> Tfiis application'form must.be completed=.in full;and`all required�irifo�mation:mu"sfbe submitted: <br /> Incompiete appfications:wiil be returned: (P/ease print) <br /> GENE� INFORMATION: <br /> Job Site ddress: '.�.� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a specia/event permit is required with Police Deparfment and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN R TION: • <br /> Name: La� <br /> State License# Expiration D te: <br /> Phone: cell • • office � • <br /> Mailing Address: Ci : ' P: <br /> Contact Person: • �s pplicant is: ontrac o / Homeowner (Circle One) � <br /> Email and/or Fax: � � <br /> PROPERTY OWNER INFORM�TI N: <br /> Name: <br /> Phone(day): ` ' Ci : iVJ 1�1 ZIP: +� 3 <br /> Address: <br /> Email and/or Fax • . <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SA wh 'E Ip1 S C.D w 1 K�k G��d`.. <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: escri 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 �etached garage ❑ Office/Commercial ❑Private Sewer <br /> ❑Other.(specify) �Q Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> ""�ny earth movement may also requi�e ❑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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ��`�'% ��v ^ <br /> � <br /> I <br />