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i <br /> � . �� 7��.7� <br /> CITY OF ORONO / <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS o��l�CY�3� � <br /> � Mailing Address: Permit number: ab!�--OD�T <br /> � PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: 6�2-�`f <br /> StreetAddress:' Received by: ci�c� <br /> ;. � 2750 Kelley Parkway Plan review fee: �8 !4�• g� <br /> �`9kESH� �G Orono, MN 55356 ��/�_�ps 4 <br /> 4 Total Fee: � <br /> Main: 952-249-466�\ Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form rllust 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: 33 -` ��z- r� ��- �f��I/ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? ❑ Yes o <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 appficant demonstrates sufficient on-site parking is available. Non-permitted events will not 6e allowed. <br /> CONTRACTOR/APPLIC NT INFORMATIO /� <br /> Name: ��i ✓�'L �5 h CF'�,/5� <br /> State License# Expiration Date: <br /> Phone: �' cell s Q •— S" office ' � - �,� " _ <br /> Mailing Address: (.`� , Cit : �c- 1 � •� ZIP: <br /> Contact Person: �,� Ap.plicant is: Con ractor / Homeowner (Circle One) <br /> Em_:;I and/or Fax: ,� � � G c�t <br /> PRGPERTY OWNER INF{�RMATION: <br /> lVame: Jcc ��.c 5 ,����'�'� <br /> F'ho ie (day): _ (� — ,�� <br /> Addr�ss: �' C- > G!� Cit :�y,C i� ZIP: ,�S ��� <br /> Email and/or Fax <br /> ARCMiTECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone !day): <br /> Address: City: __ 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 Constructian ❑ Single Family with ❑ Residence i/ <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation j�����r�� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ P�rblic ❑ Storage (�ublic Water <br /> **Any earth movement may also require [�ommercial ❑ O�er(sp cify) � <br /> MCWD review&permits. ❑ Industrial � � .zc.��, ❑ Private Well <br /> Minnehaha Creek Watershed DistriCt(MCWD) ❑ Other: (Specify) -- <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 /� � <br /> Phone: 952-471-059U ( <br /> Fax: 952-471-0682 �� <br /> www.minnehahacreek.or <br /> � ,} � <br /> Estimated Construction Valuation (excluding land) $ Gj� �C�'� ~' l 7Q L���� <br /> � <br />