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� -_ � <br /> I <br /> CITY OF ORONO <br /> ' � BUILDING PERMIT APPLICATION <br /> ; <br /> ' FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: <br /> �' � PO Box 66 Permit number: � ' U 5 <br /> Crystal Bay, MN 55323-0066 Date received: C � Z C� <br /> � � � <br /> � ; Sfreet Address:' --�-~- ' <br /> �� � 2750 Kelley Parkway .� <br /> �q �' Orono, MN 55356 ������ Plan reviewfee: ]30 , g <br /> kE5 HOR �� <br /> M in: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <br /> his application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL I FORMATION: 3 � r ' �.5��X �� /Q��� <br /> Job Site Ad ress: � v �✓l�J �S.3S� <br /> WII this be Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/ vent permit is required with Police Department and Ciry Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless pplicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACT R/APPLICANT INFORMATION: .----- • <br /> Name: - ^,� �/A.� �lS !A/'�� <br /> State Licens # Expiration Date: <br /> Phone: cell 6 o�ce � n <br /> Mailing Addr ss: � � Ol�-,� Ci : ,✓� ZIP: G <br /> Contact Per on: ,c,,.� T A � Applicant is: Contractor / omeowner (Circle One) <br /> Email and/o Fax: �,�4i,�G2i� T�A,,�� � �'Y�,,���L l�1�1 <br /> PROPERTYI OWNER INFORMATION: �� <br /> Name: ��! ✓'A� �lS �lR�✓� <br /> Phone (day : p � <br /> Address: '2p/ 1 v S��,L' r���� City: ��/`/J ZIP: ���....i � <br /> Email and/ r Fax � „vF+r�Gk/S T�R Ni���/►1/-�-l�. G�r't <br /> ARCHITE T/ENGINEER INFORMATION: j <br /> Name: G� R,� L " R r� RG�l 1�£ ��i�/Z �. �L�. � <br /> Phone (da ): / �� <br /> Address: 'E R v,�s c�t : EEP1�9�� ziP: - <br /> Email and/ r Fax: ,��L G D�/� �L� . Go� <br /> PROJEC INFORMATION: Descri tion of ro�ect: ��-� � (� <br /> 1.Type of roject 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> ❑ New C nstruction ❑ Sin le Famil with Water Supply <br /> 9 Y ❑ Residence <br /> Additio attached ara e <br /> Access Buildin 9 9 ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> rY 9 ❑ Single Family with (�Deck <br /> ❑ Reloca ion detached ara e <br /> ❑ Other: specify) g g ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '*Any ea h movement may also require ❑ Commercial ❑Other(specify) <br /> MCWD r iew&permits. ❑ Industrial ❑ Private Well <br /> Minnehah Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Min etonka Blvd <br /> Deephave ,MN 55391 <br /> Phone: 9 2-471-0590 <br /> Fax: 952 71-0682 <br /> www.minn hahacreek.or <br /> Estimat d Construction Valuation (excluding land) $ ���Q� i�� <br />