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� . � ,,� �_ <br /> � CITY OF ORONO � ���� <br /> � 7� <br /> • BUILDING PERMIT APPLICATION � �'�C� <br /> FOR NEW STRUCTURES OR ADDITtONS <br /> �O • _O Mailing Address: Permit number: 3=D 0 3 <br /> 1�l PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ( � � <br /> StieetAddress:' Received by: C�j� <br /> y�, ti� 2750 Kelley Parkway Plan review fee: 3 <br /> � Orono,MN 55356 <br /> �'�kFSHo�`�' TotalFee: oZb�3'OO�gy <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in fult and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � / l, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a special event pem►it is requi►ed with Police Department and City Council approva160 days prior to the evenk Shuttle bus se ' 'll be <br /> required unless applicant demonstrates sutficient on-site parlcing is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT INFORMATION: <br /> Name: � „� , ' <br /> State License# ��;q y B<O�.�3�rY Expiration Date: � — / <br /> Phone: cell � — / G g y 5' office fo!.�— 7!G ��-�'ys— <br /> Mailing Address: 1 O r.� mc Ci • A zc.r m.•-H ZIP: <br /> Contact Person: �G� Applicant is: Contrac�or— Homeowner �ci�cie o�e� <br /> Email and/or Fax: �� �,,� ; ,7.�,�I s.F..Q�,�-F, 5i L <br /> PROPERTY OWNER INFORMATION: <br /> Name: /)� /c d-���.,.c Pc�-c�sov� <br /> Phone(day): ��-- S <br /> Address: � �r Ci : ZIP: 6 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �C,. �. �,r�k�-rcc-rK r � <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Waber 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/Commeraal � 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 8 permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minn hahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� �(�� � <br /> � v <br />