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, , <br /> CITY �JF ORONO <br /> BUILDING PERMIT APPLICATION ' <br /> FOR NEW STRUCTURES OR ADDITIONS - <br /> O Mailing Address: Permit number: <br /> o2f�/ -U/l� � �' <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � l�' �� <br /> Str�etAddress:' Received by: <br /> � >. ...----'/x;�� ' ��d <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `��q �,� Orono, MN 55356 .� <br /> KFSH°� Total Fee: /� �'�S, , ��� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us L%r�s %/z 3 <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: > % � -� ��d jZ�"�j oZ � /�,l�.�.- _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No � <br /> If yes, a specia/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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFORMATION; � <br /> Name: S;'�?�1���L� ��c.� �a i'+'! 1�V t �-i���/Z � i n�� r� <br /> State License# Expiration Date: <br /> Phone: (�ell) �/L ��� �= !� � (office) �' "�- ��'. / �� ���,�' � ; <br /> Mailing Address: �'U S ��,�e-�j' � ��' G o n/ /�v Cit : � � j�ft ZIP: -� �/ �` � <br /> Contact Person: 'r rY,� � ��- ��— Applicant is: onf�actgi / Homeowner �c�r�ie o�e> � <br /> Email and/or Fax: ��=�-�_��� ..Sil'Y! v� ic cc�.r�� < <=�'�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �'� " "" � f7i <br /> Phone (day): !�zj 7 U� <br /> Address: �/� �!''er� Ti-t /�Gr- City: G�'L� ci ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Si �C�� �_�� �'/L G�li1 //�°L�� L"� <br /> Phone (day): � -Z 2V` � v � <br /> Add�eSS: 7�(j ` GC//]J L't/lno G- /`7 �^ ��- � CitY�.-=YJ/ �/r� ZIP: �� � ��� <br /> Email and/or Fax: � �' <br /> PROJECT INFORMATION: Description of project: <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 /> ❑Addition � attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation �,-i iz/�yv� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other. (specify) ��)N f�/r1 e���- ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> `*Any earth movement may also require ❑ Commercial �Other(specify) <br /> MCWD review 8�permits. ❑ Industrial .�°tbil.e f/r'�) ec=!`�- ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (SpeCify) ':� <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 =y+ <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 + <br /> f. <br /> www.minnehahacreek.or '$ <br /> � .3 <br /> Estimated Construction Valuation (excluding land) $ �7�� • ;s <br /> � <br /> '� <br /> � �� a <br /> . .. � � .. ... . . . . � . . . . �� '.'�`A <br /> . .. � � fi I4 � � y�`.. <br /> . .. ' .. �. . ' - . .. � u,... . . r . ... . . .E. ., . ...n t�.,. .... . .. .. 3-�3 <br />