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• <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O ` Mailing Address: Permit number: G'c /V-c)/e73.5,2 <br /> � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /4-077 <br /> Street Address:' Received by: }� '/ <br /> �' 2750 Kelley Parkway Plan review fee: ,77 O? .3 6O• �`� <br /> `� ���' Orono, MN 55356 p?Q/c,�_ c / 75/ <br /> `9kESH0 Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 5 SCrOW rted IL-9',I4- <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applicati ns,will be returned lease print) <br /> GENERAL INFORMATION: //AS /4/2 Pie ke_) /Y Ui <br /> Job Site Address: /-07 / f/ /3/0 C(,t / !'2T-N •(j2--t,j —= P1N L/j £vE <br /> Will this be a Parade of Homes, Remod 1ers Showcase Hime or other Display Home? El 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/APPLICANT INFORMATION: <br /> Name: GOknov•.) --.pt & 5 e-Otn)S-fpL7Li. <br /> State License# 3 53 tel L,I Expiration Date: qn.c N -u,i S--- <br /> Phone: (cell _5 - 2t 5 <br /> Mailing Address: Po& 3c,C,/ 51c NIt:Io+)—Cf 50:2-:-/-6 Zo..) City: Y1A-19L-g i�'&' ZIP: 5$3,5 q <br /> Contact Person: , /'gR--/A1,-, Applicant is: cetrniMitoc, / Homeowner (Circle One) <br /> Email and/or Fax: _ ., so, to, s. p} Co <br /> PROPERTY OWNER INFORMATION: <br /> Name: ./ jr /'�'A '—' Al 1 <br /> Phone (day): 95? - Z2' - G/g S z <br /> Address: 474 City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: a=/' pLAAN ) 1 ►J <br /> Phone (day): '- (. a 'VQ- 23c99`( <br /> Address: City: ZIP: <br /> Email and/or Fax: 64-)c '76 3_ r, - gD/S- <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> IQ New Construction Single Family with Residence <br /> ❑ •ddition 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.orq <br /> Estimated Construction Valuation (excluding land) $ 3 J sj-�', <br />