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. � <br /> • � �4 • <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O . `O MallingAddress: Permit number: <br /> 1�� PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> StreetAddress:' Received by;__ , <br /> __ <br /> y �` 2750 Keiley arkway <br /> �, . ,jL 5 y Plan reviewfee: �j 7�- �� .y� <br /> tq ��,L Orono,MN 55356 � � �c�__��S�__ _, ' <br /> KES H O _2�_.�_.---- <br /> - � - 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. (P/ease print) <br /> GENERAL INFORMATION: t , <br /> Job Site Address: �� Z.. SytO�('�L{,v�.� � f'l�{.. �(1p <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a special event permlt!s required with Police Department and C(ty Councll approval 60 days prlor to the event. Shutfle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking(s ava11a61e. Non-permitted events wlll not be allowed. <br /> CONTRACTOR/AP LICANT INF RMATION: <br /> Name; �p ` ��,-{� <br /> State License# G,. b Expiration Date: / <br /> Phone: cell Z� office ( <br /> Mailing Address: Cit : n, ZIP: S"�'S'.3 <br /> Contact Person: �, IE„ Applicant is: ra / Homeowner (Circle One) <br /> Email and/or Fax: (�(�( � qut �vn–"�,�,e�—('c�v�n <br /> PROPERTY OWNER INFORMAT O <br /> Name: �( 1 �,`t""r' �v r� <br /> Phone (day): (rt 2. ?�1 `3 5`BO <br /> Address: r r. Cit : (' ZIP: �,$3�y <br /> Email and/or Fax �-������ � ,��� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Yri,i I��e. Q E }�r�2 <br /> Phone (day): G�Z qy�Tt,t �, 6 g�, <br /> Address: Cit : ZIP: <br /> Email and/or Fax: � ,�p .� � Tc� tvw ard aS�al1. CCJ�� <br /> �— <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑�New Construction �Single Family with �Residence <br /> 4ddition attached garage ❑Garage/Accessory Bldg. �Public Sewer <br /> LJ Accessory Building ❑ Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other: (specify) 0���` ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage �ublic Water <br /> '''Any earth movement may also require ❑Commercial 0 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) $ _ �'' j �/�� <br />