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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OqT Mailing Address: � CyV1 Permit number: <br /> 1 VO PO Box 66 7-k3-13 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> yF 2750 Kelley Parkway Plan review fee: <br /> kC�� Orono, MN 55356 Total Fee: �f�f [1 <br /> `gESH /i ! / <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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �1�h5 j�b�le�cc�C D-ZLrt_ (_V300; <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 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: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: `nn <br /> Phone (day): c61 l <br /> Address: 16' City: OV60-r-- ZIP: <br /> Email and/or Fax dean. re4g r w.n� tv�411,1.�o�rn <br /> ARCHITECT/ ENGINEER INFORMATION: ►'� tom' <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <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) t�D aq ❑ Multiple Family/Condo ❑Warehouse <br /> J� ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial Rr Other(specify) <br /> MCWD review&permits. ❑ Industrial Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other: (specify) <br /> 18202 Minnetonka Blvd ria e' <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br />