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CITY OF ORONO h <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: a0/�e)1,;z � <br /> ON PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> y <br /> Received by: <br /> Street Address:' —7 <br /> -76 <br /> 2750 Kelley Parkway Plan review fee: <br /> `• � `�� Orono, MN 55356 <br /> tio 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: f (A <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes NNO <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/AP LICANT I O ATION;_ <br /> Name: 'u1 G� S <br /> State License# Expiration Date: <br /> Phone: cell office <br /> Mailing Address: Cit ZIP: '' <br /> Contact Person: Applicant is. Co r ctor / ner (Circle One) <br /> Email and/or Fax: Cyt <br /> PROPERTY OWNE INFORMA 10 <br /> Name: S <br /> Phone (day): - <br /> Address: r' r Cit to ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGIIR INF�RAfIATIQN: , <br /> Name: <br /> Phone (day): /��I _ -7 _3 <br /> Address: � City: ZIP: <br /> Email and/or Fax: , eiot <br /> PROJECT INFORMATION: Descri tion of projeft V1 L <br /> 1.Type of Project 2. Proposed Use 3. ructure Type 4.Sewage Disposal& <br /> Water Supply <br /> VAConstruction ❑ Single Family with ❑ Residence <br /> tion attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ssoryBuilding ❑ Single Family with Deck <br /> cation detached garage ❑ Office/Commercial E] 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.minnehahacreek.or <br /> $ 1 <br /> Estimated Construction Valuation (excluding land) <br />