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� � � � � <br /> CITY OF ORONO I � �j <br /> BUILDING PERMIT APPLICATION / � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailin Address: , / <br /> �QA TO 9 Permit number: / �-- - � <br /> 1 V PO Box 66 � <br /> Crystal Bay, MN 55323-0 6 Date received: - <br /> i <br /> Street Address:' �� �q i� Received by: <br /> ti�, � 2750 Kelley Parkway'" �� Plan review fee: , <br /> �qkFSHO�@,C' Orono, MN 55356 a�1 S' _U-j, <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us ' {rQN�� VUI��t� <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: / � 3 �-- � ��;���-� I , „� v �(� <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 approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: 5� l'�'�Iney" t,�1 � �� i„ �, ..Zh� <br /> State License# �3t� c;,ZG�C� � 5 Expiration Date: 3 3i ' <br /> Phone: (cell) ��Z� 22 t - > ; Dal (office) c�2 9�Z �7N -L�i �-1 (a <br /> Mailing Address: �-rv- ��� r� v�c L��+.r� - City:�U��1�.� �c�-� ZIP: �y�,�� � <br /> Contact Person: `�-k-�.r�G Applicant is: Contra r / meowner (Circle One) <br /> Email and/or Fax: �;5 L - 4 7�1- 2\C�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��r_E� ��t��r..,� )v��tn�.;�c:�� <br /> Phone (daY)� i�f 2^-� ��l " �75',Y,C; �.. <br /> Address: t�3�.. -- .'���r ��� � . Cit : Ult�e� ZIP: 5 ��L <br /> Email and/or Fax � � ,G,h � -�,� r �,r1, e� ,, J (�;,�.�,�, <br /> ARCHITECT/ ENGINEER �NFORMATION: <br /> ►vame: 13� �` ����c;t� �v.t:. . <br /> Phone (day): q5 2-- 7�� �7��... <br /> Address: Cit : ZIP: <br /> Email and/or Fax: `��Z,, '7 (y �-- '1^, <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> evr�6enstn�ctivn �,Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> r] Relocation detached garage [� Residence ❑ Private Sewer <br /> � Other: (specify) �h s. ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> �earth movement may also require ❑ Commercial ❑ Storage <br /> ` review&permits. ❑ Industrial ❑Warehouse (�Private Well <br /> a Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(speCify) <br /> \ �etonka Blvd <br /> � MN 55345 <br /> � '1-0590 <br /> �82 <br /> eek.or <br /> 1�,7 t� <br /> �ction Valuation (excluding land) $ �5V;(.'V� r <br /> January 2015 <br />