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w <br /> .�, , <br /> ` CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �i O Mailing Address: Permit number: �Ol�—�D (0,3 /, <br /> PO Box 66 <br /> r 0 Crystal Bay, MN 55323-0066 Date received: �7"�('"� � <br /> StreetAddress:' Received by: i •1 <br /> �� G` 2750 Kelley Parkway Plan review fee: �.53• <br /> lqkESH���, Orono, MN 55356 dQ/3—b O� <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 b ubmitted. g•���?j <br /> Incompiete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ?,� �-; c <br /> Will this be a Parade of Homes, Remodelers howcase 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. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: 5i�: JREc" Lu►.�� l.�sWnSG.aJ�F <br /> Name: �.IF"_.� _ � L � "'� . �u e� <br /> State License# ���,3�.r3u� Expiration Date: ,i <br /> Phone: (cell) �,i2 SoB -�U3�t (office) �r2 �� p)91 __ _ <br /> Mailing Address �� 2,3 �, � Cit : rt,�i � ZIP: ;r',� � <br /> Contact Person: ���,,t� pSMU��GSON Applicant is: Contrac o / Homeowner (Circle One) <br /> Email and/or Fax: $��„���y�,�,:�;,Q����D�S1►.i�, c�rv� t-�� �iS'2:�j3S 6�2� <br /> PROPERTY OWNER INFORMATION: <br /> Name: 'j"p�'✓� � St.��'h���I��l� <br /> Phone (day): �c�4rJ — C t"Z•��t 1 -2�tyH <br /> Address: 3pa �ugQf �Qy �a,p City: ���,_,� ZIP: SS3S� <br /> Email and/or Fax ^FL��,,,��.,�3 � C�r�e�� e r�C� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �bu�� �+h� � p�-�3a.e- <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 ❑ 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 G�Ctflt1� .S��a�6QR.[.� ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other: (speCify) <br /> 18202 Minnetonka Blvd �p�p� SNID N� <br /> Deephaven,MN 55391 ' <br /> Phone: 952-471-0590 �Oa'�`'►➢�c.+-��J <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> c <br /> Estimated Construction Valuation (excluding land) 1'3, G1�1�� <br />