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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION 5c1. <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0 Mailing Address: Permit number: Zo <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006611 D Date received: Fit zz Ig <br /> Street Address:' Received by: <br /> �F 2750 Kelley Parkway Plan review fee: Z g,7 , <br /> q <br /> Orono, MN 55356 <br /> ��kESH°��` Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us a- )C_ 0AIM10,1t,t A 'KC <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: J ,00 wGt-tGYtOtc�e1 LOh �K� COror, o J <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 <br /> Name: 7bpeyll , M t n ri e_a 00 6 <br /> lls - V-Age_ �Vd ere, <br /> State License# `fp Expiration Date: <br /> Phone: (cell) (i�- office <br /> Mailing Address: S c C. 'rc - Cit P l_s . A/ ZIP: 5 5 3 5 <br /> Contact Person: Joe v Applicant is: / Homeowner (circle One) <br /> Email and/or Fax: /fit C CO►'11 <br /> ROPERTY OWN R INFORMATION; <br /> Name: G r�l( G� Q fl <br /> Phone (day): a-1I-Z 3 - `10 10 <br /> Address: 13 iso VJ e 0Wh City:Lcmq LGA-ke_ ZIP: <br /> Email and/or Fax __b_f-M ar tl•n OR a�0 V�hna , CO rN <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: n <br /> PROJECT INFORMATION: Description of project: V ��tac_.�64 e'ctracl e, <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 ❑ 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 /> 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) $ C)0O <br />