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((24"f/3 <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �o V Mailing Address: Permit number: p2()/3-0,5:5,- <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ,6-7?V 4 <br /> Street Address: Received by: <br /> *114' <br /> L2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> kESHOS" Total Fee: 4' <br /> 0 /` <br /> t�g <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: �J <br /> Job Site Address: VY?Q �ciPt/0 c./.4/ c�v Nc./.4 Mit7,5 J 1'S `7- <br /> Will this be a Parade of Homes, Remodelers Showcase Hoene or other Duplay Home? 111 Yes lel No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days p r 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: .,Sc_.4-) <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: 6-?4/ C�e/�e <br /> Name: <br /> Phone (day): 9,532-2)- / -9„77 <br /> Address: ycf90 4./a f r-{��-.� ,� /� City /A, ZIP: ,53Y,5-9 <br /> Email and/or Fax �/ �!p /Y 7`5 ��^.Gc�fson Com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 El Single Family with ❑ Residence <br /> El Addition attached garage ❑ Garage/ « -ssory Bldg. ❑ Public Sewer <br /> ❑Accessory Building El Single Family with ❑ Deck <br /> El Relocation l f detached garage El Office/Co mercial ❑ Private Sewer <br /> ❑ Other: (specify) �t�eC I Z 46 ❑ Multiple Family/Condo El Warehous <br /> [' Public l Storage ❑ Public Water <br /> **Any earth movement may also require El Commercial ❑ Other(spe« ) <br /> MCWD review&permits. El Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) El 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) $ <br />