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CITY OF ORONO <br /> / <br /> 4 BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> fp4w ✓� O Mailing Address: Permit number: <br /> POBox 66 c������� , to <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> S� y 2750 Kelley Parkway � �rvh (C`[ I_ anreviewfee: <br /> <1 •' O�`�C Orono,MN 55356 <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: 2 WLAfL U R..Le <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: "Pik) DECKS <br /> State License# %(.636111 Expiration Date: 3/31/17 <br /> Phone: (cell) %Ljt-'245- 67,66 (office) <br /> Mailing Address: lsor., vicie-s gupl., i ,•, }§9)2_ City: _paYwl uTi3 ZIP: 5'I11 <br /> Contact Person: NI L M v i2T1.1A Applicant is:<-Contr'actor / Homeowner (Circle One) <br /> Email and/or Fax: Nit.@ PHit,MNFSvT . Corte <br /> PROPERTY OWNER INFORMATION: <br /> Name: MAUAsA Nlc,1t— EO6SSFJQ- <br /> Phone (day): <br /> Address: ? 50 City: Oftor.Jb 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 /> 15" (o <br /> PROJECT INFORMATION: Description of project: ��D c�_/ / <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑ New ConstructionWater Supply <br /> Single Family with 0Residence <br /> a Addition - DV-14- attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building 0 Single Family with Deck <br /> ❑ Relocation detached garage ' ]Office/Commercial 0 Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo ❑Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> ""'Any earth movement may also require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) ❑Private Well <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) $ Ili O03 <br />