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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION01 <br /> i'{410 <br /> �� <br /> FOR NEW STRUCTURES OR ADDITIONS CJ` - UA <br /> O!V <br /> A, Mailing Address: Permit number: c�D�rj_ <br /> VO <br /> Crystal Bay, MN 55323-0066 Date received: f — f <br /> Received by: <br /> Street Address:' (,! , ( tr/W1 <br /> 2750 Kelley Parkway r�i)t ) Gf`c lan review fee: 0 t Orono, MN 55356 <br /> 4kESH09-� <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: a50 E IRCI <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: Poi DECKS <br /> State License# 636111 Expiration Date: 3/31/13 <br /> Phone: (cell) 2-)S- 67,66 (office) <br /> Mailing Address: 3500 ‘,4iri�S g,,;zG, LN 30z City: pc yw, 0TH ZIP: S 5,4111 <br /> Contact Person: NI L M v 2 r uA Applicant is: ontiactor / Homeowner (circle One) <br /> Email and/or Fax: PN) PH,MINN F917✓. Ca v <br /> PROPERTY OWNER INFORMATION: <br /> Name: ivlai2t,o►k tvicl� Eu�iSiFJ.. <br /> Phone (day): <br /> Address: C I GL City: orLoNib ZIP: 55356 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: 21-6l5XI 4 - 1 c <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 /> 25 Addition • i ECV- attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with10 Deck <br /> ❑ Relocation detached garage Office/Commercial 0 Private Sewer <br /> 0 Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage 0 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.org <br /> Estimated Construction Valuation (excluding land) $ Il7 OO() <br />