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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: �0/ —D O /7 <br /> PO Box 66 p <br /> Crystal Bay, MN 55323-0066 Date received: O -I q- � � <br /> Street Address:� Received by: � S <br /> � �' 2750 Kelle Parkwa <br /> �F G` Y Y Plan review fee: <br /> Orono, MN 55356 <br /> `qkFSH��� Total 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: �966 5�}�c�`{ WO�D� Qo <br /> Will this be a Parade of Homes, Remodelers Showcase Ho e or other Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 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 INFORMATION: <br /> Name: Q�,t�,��. <br /> State License# Expiration Date: <br /> Phone: cell office <br /> Mailing Address: ' Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: "� "" <br /> PROPERTY OWN NFORMATION: <br /> Name: �i��c� <br /> Phone (day): 'Z <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEE INFORMATION: <br /> Name: <br /> Phone (day): • <br /> Address: Q{� � ' Cit : ZIP: <br /> Email and/or Fax: , <br /> PROJECT INFORMATION: Description of project: • <br /> 1.Type of Project 2. Proposed Use 3. S cture Ty 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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public 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.m i n ne h a h acreek.o� <br /> Estimated Construction Valuation (excluding land) $ �j�. <br />