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To: Permit Desk Page 2 of 6 2015-07-13 20:21:56(GMT) 15072999410 From: AMANDA BINSTOCK <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEIN STRUCTURES OR ADDITIONS r^/ <br /> MailinngO Bdod>es6s. Permit number: / 'O�a 5 <br /> Crystal Bay, MN 55323-0066 Date received: /J <br /> Street Address:' Received by: <br /> 2760 Kelley Parkway Plan review fee: _ <br /> Orono. MN 55356 <br /> Total Fee: <br /> i <br /> -~Main: 952-249-4600 Fax: 952 245-4616 ,w�rr.ci.orona.mn.us a <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: 6-7 q co Tu <br /> Will this be a Parade of Homes, Remode rs Showcase Home or other Display Home? El Yes <br /> ❑ 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 wilt be <br /> required unless applicant demonstrates sufficient on-site parking is available. Nan-permitted events will not be allowed. <br /> CONTRACTOR!APPLICAN,T INFORMATION: <br /> Name: C ow.0,61 t St wuw4 <br /> State License# I H -) _ Expiration Date: i <br /> Phone: cell (office) 7-3�7 G S <br /> Mailing Address: �} Yd iA UK _ Cif h -b ZIP_ (na <br /> Contact Person: Applicant is: ontr / Homeowner (Circle one) <br /> Email and/or Fax: Nv� _t.(5yh l 9111�t M C C <br /> PROPERTY OWNER INFORMATION: <br /> Name N Yt <br /> Phone (daY): <br /> Address: <br /> Email and/or Fax <br /> ARCHITECT! ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): City: <br /> ZIP: <br /> Address: - <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. E] 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) ❑Other: (specify) <br /> 1 B202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone 952-471.0580 <br /> Fax 952-471-0582 <br /> wrww.Winnehahacreek.o.r9 _. 7 <br /> Estimated Construction Valuation(excluding land) $ 3 I L ' ?" <br />