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� <br /> ' , . � . <br /> CITY OF ORONO `���y <br /> BUILDING PERMIT APPLICATION N� �• <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O t _ MailiPO Bo�r66. Permit number: �� <br /> 1��0 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> � <br /> StreetAddress:' Received by: <br /> ti G��'' 2750 Kelley Parkway Plan review fe � <br /> `� Orono, MN 55356 / <br /> r�KESHO�� /�j V/�'�' /V <br /> Total Fee: -� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us V <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: o?o?S �'t' /P� 6 ��� <br /> Will this be a Parade of Homes, Remodelers owcase Ho e or oth 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. 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/APPLICANT INFORMATION: J <br /> Name: �o� rd (eaniw e�— �o'hs!!'vc��o✓1 <br /> State License# Qp Expiration Date: .Zp <br /> Phone: cell office <br /> Mailing Address: 96�? / T'� ���+u� Cit : .+•,ed ZIP: S".S'^�S/ <br /> Contact Person: Applicant is: Contra or / Homeowner (Circle One) <br /> Email and/or Fax: /Ij iC�C � ��e�4a►:� . c+v�+ <br /> PROPERTY OWNER INFORMATION: <br /> Name: J' s s�ibr�n <br /> Phone(day): 7 G 3 •. �2 � � <br /> Address: Co „ �Q Cit : ZIP: <br /> Email and/or Fax ,P ss e . d 4 ti�s'y'�o�r►,C c•�-�o.l. m�, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with �esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation • detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other: (specify) �r�/'trD��r ❑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) ❑Othef: (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) $ �'f, 7�8. a6 <br /> ,. <br />