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� t� <br /> CITY OF ORONO � �� <br /> BUILDING PERMIT APPLICATION�-� � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O ` Mailing Address: Permit number: ��� � �� � <br /> �I�TO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 9' —� <br /> Sfreet Address:� Received by: <br /> y � 2750 Kelley Parkway Plan review fee: � <br /> `�� �,� Orono, MN 55356 <br /> �KESH�� ��l � <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3 3 �� �G o i� /�h � �<�' - <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�I'�o <br /> If yes, a specia/event permit is required with Polrce Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI NT INFO ATI N: <br /> Name: �i /�2 C - <br /> State License# Expiration Date: <br /> Phone: cell office <br /> Mailing Address: O , Cit : �;� � > ZIP: , `"� <br /> Contact Person: � _ ,� ' Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: . <br /> PROPERTY OWNER INFORMATION: <br /> Name: � � �- �i r � <br /> Phone (day): , l ��/ 1� <br /> Address: h �'7 O �' �'. � �.� � �_1�� `JlN" �iP: ����-� 1 � <br /> Email and/or Fax � ;;,,�_y�s.«,�>� � l� �,-�-j�,-, �L�� <br /> ARCHITECT/ ENGINEER INFORMATION: I � <br /> Name: 1� :-��r � � h � 7,,,-, �� � �_ J , � � �, - . <br /> Phone (day): r� /� - z 27�-- — ,L( G/"3 (� ���IP: <br /> Address: ����� <br /> Email and/or Fax: <br /> � <br /> PROJECT INFORMATION: Description of project n��P� fl, ��' � >� ::� - — �z.���'` <br /> 1.Type of Project 2. Proposed Use 3.: vage Disposal 8 <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> �Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ccessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) �C �t,2 ❑ 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 ❑ 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) $ / d G�O v <br />