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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0 Mailing Address: Permit number: <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> y� 2750 Kelley Parkway I I Plan review fee: <br /> L <br /> `gOrono, MN 55356 ]0SHO�� -;96) <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 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: _3111 0 1_0 'R_ 01 n%)O Y qI i <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes LYNo <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: �,� J—At� (Ding()CI.0 k) <br /> State License# C a?Zg�ZS Expiration Date: X3 t 1h <br /> Phone: cell - office —� <br /> Mailing Address: '� Ci ZIP: <br /> Contact Person: _ Applicant is: <-_��on acto / Homeowner (clrcle one) <br /> Email and/or Fax: DA144 M� cl <br /> PROPERTY OWNER INFORMATION: <br /> Name: L_&e Li U124 P0i'�-_C50A1 <br /> Phone(day): 4/502 - L41Z - ZZL_ - t4/-/DA <br /> __3110 j <br /> Address: "1( p(,0RD f C*0,Q0 City: ZIP: 573V <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER I FORMATION: <br /> Name: HOP rk041T_eC1- z e6- <br /> Phone(day): q,5.1 Z50-,4V45- <br /> '! <br /> Address: 5-#21 � 514 y1f d Ai/1_ City: 1404_ f�P: 5_S` (OL <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion 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 /> WAccessory Building 2r 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) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ Z-:54- QiX - -v <br />