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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number: l�C��� ���� � ���-�-'`1 <br /> � �TO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: (�' Z 7 /� <br /> --Receiv�d. �"C'!`, <br /> Street Address:' ' � -, ,�, �`�-- <br /> y � 2750 Kelley Parkway�,:`i '`s ' �-` � l' �� =; . " � . �� � <br /> Plan review fee: �c�.� <br /> `�l �� Orono, MN 55356 —_j <t.___ ------__ _ . ---- <br /> �KESH�� .__. ___ _ <br /> Total Fee� ��// -7/ y S <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 sub itte . C r�s9 �L/�/�c� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �.�� ��' �-q��'►�-��.� ����,�,� <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 Counci!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 be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: ' �^ �� �(:�� Y' ��c.%l(.,,�lt��`�; <br /> State License# ; � � 7— � C� Expiration Date: �' � l.d <br /> Phone: ce I office <br /> Mailing Address: ;: '�L �2 �.;( Cit : 's� rF..4���:::�_' ZIP: `a ;, '� �. � <br /> Contact Person: r ,,�,� �� ' � � Applicant is: ontractor ;/ Homeowner (CircleOne) <br /> Email and/or Fax: � (t r��} � t'l �-%L1�j�JZ.i?, !�U(t.�i(��;, .( (i j -., ---.__� <br /> PROPERTY OWNER.INFORMATION: <br /> Name: ��L��J '�� % t�"K-1J (�(��-t'`' <br /> Phone (day): ;� , <br /> Address � 5 1�' - V�,i,'(� ( L,%� City: _. rZ�lL •`� ZIP: <br /> � <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,j ����i� i;�+�-1" I.� ��'��--r�C�'�-�) <br /> Phone (day): �� <br /> Address: i i � �'t City: ZIP: <br /> Email and/or Fax: <br /> q{; �Z�%� [.r , w� <br /> PROJECT INFORMATION: Description of project: �����C � ='�%''� ���' �-.��''� ����� � rt'--���C'�� ` <br /> 1.Type of Project 2. Proposed Use 3.Structure Ty e 4. Sewage Disposal � <br /> Water Supply <br /> �ew Construction ❑ Single Family with ❑ Residence <br /> ddition 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) ❑ 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) $ � I C�� ��'Q <br />