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CITY OF ORONO bf-�, 7/813 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Nailing Address: Permit number. <br /> 1 YO PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> y 2750 Kelley Parkway Plan review fee: <br /> 6SH04G Orono,MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax 952-249-4616 www.ci.orono.mn.us T� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job site Address: _ 70k R f- C' 10/10 56 3-�6 <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 Pollee DepartneAt and City Council approval 60 days prior to the event Shuttle bus service will <br /> required unless applicant demonstrates suff6ent on-site parking is available. Non-permitted events w#1 not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 6PiIW60 Akr,-ac vi Acte n h Ind - <br /> State License# _ Expiration DXe: <br /> Phone: cell v office <br /> Mailing Address: 2 City: p ZIP: <br /> Contact Person: g,p1AzLe #X�y&ik6 Applicant is: Contractor I orneown (circle one) <br /> Email and/or Fax: C rl'�± Q al. , C►p Yl— <br /> PROPERTY OWNER INFORMATION: <br /> Name: 13RJAAI t:11 11' tt�lfiJCa 4- Abe Gef7 L . n , <br /> Phone(day): YS Z- 7 3 -02E3 <br /> Address: Z-41 i- 7`D - X-re City: ZIP:2z t5�'_?_ _ <br /> Email and/or Fax l <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): _ <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro, ct: <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 ZDeck <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 /> 16202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952.471-0590 i <br /> Fax: 952-471-0682 <br /> www.rninnshahacreek•or4 <br /> p0 <br /> Estimated Construction Valuation(excluding land) $ 70o.. <br /> ,;�,6a© <br /> ` x; ;,, 00, <br />