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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���� Mailing Address: Permit number: Q- -�Q <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: ' � <br /> Street Address:' Received by: <br /> � �` 2750 Kelle Parkwa <br /> ti�, G` Y Y Plan review fee: <br /> Orono,MN 55356 <br /> tqkF��o'��' Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in fuil and alf required information rriu§t t�e submitted. <br /> Incamplete applications witl be returned. (Please print) <br /> GENERAL INFORMATION: ,,,, ��j <br /> Job Site Address: � �� [,c�OC�� !�`-`' <br /> Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑Yes No <br /> lf yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will 6e <br /> required un/ess applicant demonstrates s�cienf on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN INFORMATION: � <br /> Name: � � �d�,S <br /> State License# Expiration Date: <br /> Phone: cell . — office � <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: on ractor / Homeowner (Clrele One) <br /> Email and/or Fax: — <br /> PROPERTY OWNER INF RMATION: <br /> Name: i ` � <br /> Phone (day): _ <br /> Address: Cit : � ZIP• S <br /> Email and/or Fax f�i o '' 1 ' C r1�•''�Y� � <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: ���C.-��-- � �� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8�� <br /> Water Supply !,� <br /> ❑New Construction �gle Family with ❑ Residence <br /> ❑Addition ^ attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building r�,�y�u./�.G�' ❑ Single Family with ❑ Deck <br /> ❑ Relocation � -J detached garage ❑Office/Commercial ❑ Private Sewer <br /> `�Other: (specify) C./�G� ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑Commercial `�:Qther(specify) <br /> MCWD review&permits. ❑ Industrial ra C`�O ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other: (Specify) cn <br /> 18202 Minnetonka Blvd �/A�� <br /> Deephaven,MN 55391 �� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � <br />