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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A TO Mailing Address: Permit number: <br /> l V PO Box 66 Ul 15 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 'r 2750 Kelley ParkwayPlan reyew fee: <br /> Fl1krSHoL Orono, MN 55356 e <br /> o ee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us VoNaL <br /> This application form must be completed in full and all required informati n must be submit /�1 <br /> Incomplete applications will be returned. (Please print) �7"l <br /> GENERAL INFORMATION: L <br /> Job Site Address: /070 Tnk awa RoJ <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/APP CANT INFOMT%M.0, <br /> Name: LL.— <br /> State License# jgc (o3S245' Expiration Date: 'JVZ;V 7-0 1-7 <br /> Phone: cell office 46(2-3159- ►"73) <br /> Mailing Address: 19-05-0 237Aw .m. City: l AI ZIP: y <br /> Contact Person: dl&&L , Applicant is: C ntra or omeowner (circIe one) <br /> Email and/or Fax: @ (� <br /> PROPERTY OWNER INFORMATION: <br /> Name: Pal E Lak f-a <br /> Phone (day): <br /> Address: /030 ow 1e&.Jr. City: Orono ZIP: S5i 3,5L <br /> Email and/or Fax rcy.)l I arwVCV P_W&%IZ(7ar C.r^ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: C',h X_v(t.Syo 4 )JeNzvo C.C.Phone (day): 612 -3 S 173 <br /> Address: 0�0 Z3 City: Pt QIP: -5Sigq <br /> Email and/or Fax: corms <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type <br /> ❑ New Construction ❑Single Family with ❑ Residence VF-1Addition attached garage ®Garage/Accessc p V� <br /> ®Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commerci <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage <br /> **Any earth movement may also require ❑ Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial riv <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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) <br />