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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: z/V-(Jfl / o <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> y 2750 Kelley Parkway Plan review fee: l4/5E 7 <br /> CgOrono, MN 55356 <br /> kESHO <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 required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� <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 wil e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP LIC NT INFO ATION: <br /> Name: r �fl L <br /> State License# Expiration Date: LO <br /> Phone: cell ► office '_Ro S <br /> Mailing Address: CC City: ZIP: _ S <br /> Contact Person: r Applicant is: COntrac / Homeowner (circle One) <br /> Email and/ AC 77—) 12'Wc1,A �, CL <br /> PROPERTY OWNER INFORMATION: <br /> Name: 0,_" L <br /> Phone (day): CO 1 a ^ \ - f <br /> Address: City: ZIP: <br /> Email and/or Fax olI na . <br /> ARCHITECT/ENGINE R WFORMAT1C <br /> Name: 6Y c ti <br /> Phone (day): <br /> Address: 00 t Cit r1,Q ZIP: <br /> Email and/or Fax: %v p ^ c� <br /> PROJECT INFORMATION: Description ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> KA' ew Construction Single Family with ZI Residence <br /> ddition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial Do 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 P,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.org <br /> Estimated Construction Valuation (excluding land) $ C) I lJ <br />