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10/28/2015 8:54AM FAX 7638561391 CRAFTSMANS CHOICE INC 20002/0003 <br /> r <br /> i <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES 0�1 ADDITIONS <br /> Mailing Address: <br /> {Vp PO Box 66 Permit number: / – / <br /> j Crystal Say, MN 55323-0066 Date received, <br /> Street Address:' Received by: <br /> o 2750 Kelley Parkway Plan review fee: <br /> lA Orono, MN 55356 <br /> Kr5H04' <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 req iced information must be submitted. <br /> GENERAL INFORMATION; Incomplete applications will be returned. (Please print) <br /> Job Site Address: ­F <br /> tcL A-VC- Qf0(\D <br /> Will this be a Parade of Homes, Remodelers Showcase Home or 6 ther Display Home? ❑Yes YNo <br /> lfyes,a special event permit is required with Police Department and City Council approvail00 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su>'ficrent on-site parking is available. Non-permitted evanta will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: r A <br /> State License# Expiration Date: <br /> + <br /> Phone: cell office nCe3 aZ(0 -1ytos <br /> Mailing Address: irk-y _ fjU : M:C 1 ZIP: <br /> Contact Person: bGC Applican is: ontractor � Homeowner (Circle one) <br /> Email and/or Fax: cO I(.,L Corm -7 4P--7LA4 <br /> PROPERTY OWNER INFORMATION: <br /> Name: OV Yrr*,'1 <br /> Phone(day): _n -_L/qL? <br /> Address: rWp, v-(-^ city; rbty) ZIP: 5� <br /> Email and/or Fax n-.art ,'►-� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use3.S ructure Type 4.Sewage Disposal& <br /> ❑New Construction SWater Supply <br /> ingle Family with f�esidence <br /> �]Addition attached garage ❑Garage/Accessory Bldg. E-1 Public Sewer' <br /> El Accesso ryBuilding ❑ Single Family with eck <br /> p elocation - detached garage ❑Office/Commercial <br /> H Other:(specify) (-'(�1d a°. �Y oc��cs,. Private Sewer <br /> © Multiple Family/Gondo ❑1lPrehouse <br /> 54tg br.1+-I Public ❑Storage El Public Water <br /> *"Any earth movement may also tequire ❑Commercial ❑Other(specify) <br /> MCWD review&permits. M Industrial I ❑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: 952471-0682 <br /> minnehahacrcak.o( <br /> Estimated Construction Valuation (excluding land) $ <br />