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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � <br /> ��7. �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �- O `"�\ Mailing Address_ o?U l 3-D��� <br /> ! � ^/ PO Box 66 Permit number: <br /> � `•. Crystal Bay, MN 55323-0066 Date received: ,.S l3 ' �-3 <br /> � ' Street Address:� Received by: � <br /> � t � � `� <br /> -�� � � .' 2750 Keiley Parkway Plan review fee: - D�37 / G� <br /> `��q ���;� Orono, MN 55356 /�3.B � <br /> K�s H°�� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 �����titiv ci.oror�c, ,"�,�, us �,10� �- <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: / � � � � '�.J� ' <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑ Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service ill e <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � I _ <br /> Name: �,F' t Z �� u-�LC�L1] ��J'� <br /> State License# �L �,p ��,-����s Expiration Date: �--`�—%�_ <br /> Phone: cell - Z ' office � � <br /> Mailing Address: Ci ` IP: '' ,�S <br /> �:p�t,a�t Pers� Applicant is: Contract / Homeowner (Circle One) <br /> -`_mail nd/o Fax � 3E;� �' ' — - <br /> PROPERTY OWNER INFORMATION: <br /> Name: MiC�y�-�/�r'9 �lf'�P C_IC 5 <br /> Phone(day): :(J/'I,L��; ZIP: j<� <br /> Address: j�, 'ti ,S /�y t,cJ City <br /> -� <br /> Email and/o�Fax m ��1Q�IQ a �f i�rC!<: � `a�l� ��wz <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <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 8� <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) r7c.L�-t L�xi ❑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 /> $ "•� <br /> Estimated Construction Valuation (excluding land) ,�,; (�� <br /> � <br />