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A' • / s1 4, 17-i3 <br /> AAS CITY OF ORONO <br /> BUILDING PERMIT APPLICATION '04-. 57 7S <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number: 4:26/3-D D (p 7 <br /> �CI*..4 <br /> T PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-7- /3Street Address: Received by: 66-5 <br /> 2750 Kelley ParkwayPlan review fee: /(oZ �1g <br /> kFSuov-- Orono, MN 55356 2D/ -0,`f&,3 <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: iir,97 a r- ;e,J'k- /? <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/APPLICANT INFORMATION: <br /> Name: .>el <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: / / • <br /> Name: �/e r -�/17�cha..e_4 eif <br /> c_- el - <br /> Phone (day): • - •,• <br /> Address: zrno CEJ /er ,r✓., /2 � City:/hr/e,4,-� ZIP: 6313 S 7 <br /> Email and/or Fax cfrP/hec y / 4r-in ni�� <br /> r hits-/ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: i/'- <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 /> ►'i Addition _')cz:k attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building IE 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) $ /t`000.00 <br />