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�d�'� <br /> ' ' CITY OF ORONO ,I� � <br /> � q`�' <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �0/ —�7d� <br /> PO Box 66 ' / <br /> Crystal Bay, MN 55323-0066 Date received: 7- �/ 7` <br /> � <br /> StreetAddress:' Received by: <br /> 6� G�` 2750 Kelley Parkway Plan review fee: � �3, <br /> l,9K�SHo�F, Orono, MN 55356 ��Q`�����3 <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: � �/j�% � �= � � �: <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. Shuttfe bus service will be <br /> requrred unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP�LICANT IN�ORMATIO : <br /> Name: ����,'.�lE� �'��,�� �� �o� <br /> State License# � Expiration Date: <br /> Phone: (cell) � (� -- "�S_p '� � � � (office) <br /> Mailing Address: �C � � Cit : , r� .--� � ZIP: <br /> Contact Person: ;r"r �ui��l 9S� Zo f 5�3� Applicant is: Contractor / 0111@OWI12f (Circle One) <br /> Email and/or Fax: " <br /> PROPERTY OWNER I RM�4TION: <br /> Name: ��' . ��-- �� !� <br /> Phone (day): S b I � <br /> Address: b C F> <<-c_ Cit : �: �r.n C ZIP: <br /> Email and/or Fax 1 Q�'YY�Qh�`IlOi' QYhQ.I.�•Cf6ri'� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> rn�.ic�:i iiVirllFZIVIA i IUIV: Descnpuon ot projeci: <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 detached garage ❑ Office/Commercial ..0'"Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may also require ❑ Commercial ❑ 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) $ ��,Q�'r �_ <br />