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, � <br /> , , CITY OF ORONO � �-� � <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS � �-��� <br /> �O�O Mailing Address: ^ Permit number: �/ -�j/O � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �l 9 —/ <br /> ��(��` Street Address:' a,NL �� Received by: <br /> ti� G� O' 2750 Kelley Parkway C1 � v Plan evi fee: I�. 3/ <br /> lqk�SHO��, ( Orono, MN 55356 � 'j,� C� � � D/�_v/U� <br /> 1" otal Fee: �._._.�_.._�._.---_____�.._.� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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: !� 1(� ; �-(t7,��r �-��r�J r��` <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �-1'r� ��n.� 5.r-�">wcTrc�., r�JC . <br /> State License# �y5�",s Expiration Date: <br /> Phone: . (cell) � �Z - �435-- S��L �7 (office) 3 Z�- - Z-75 -- 3 �� �7 -7 <br /> �lllailing Address: Cit : ZIP: <br /> Contact Person: ��� _„�,,,��v ,S �- Applicant is: ontra tc or ��/ Homeowner (Circle One) <br /> Email and/or Fax: ���� �= L , r_F��Ns T�z.��-Tlc,r.� i r�L� C�--, .-�-� � <br /> PROPERTY OWNER INFO„RMATION: 2 <br /> Name: ��-�-�w�1'� �F � .��n-�ti�r ` � c v-I �1 ��i�st,u <br /> Phone (daY): (,.�� -- �f��, — ?[`�rjrj <br /> Add ress: _I�! c 5.e�',�,r o 4 � . , �,�-,,� V� City: �,�.,,�'�`z�i z� ZI P: ���� � <br /> Email and/or Fax � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: o� F /f�t�t- �v �/�¢u o��. <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �ingle Family with �esidence <br /> Addition attached garage ❑ Garage/Accessory Bldg. �ublic 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 �ublic 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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �?' G�Cic <br />