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i f <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION At PAO <br /> FOR NEW �� <br /> STRUCTURES OR ADDITIONS CJ` - <br /> (� Mailing Address: Permit number: <br /> *4` <br /> PO Box 66 ( DIS-�� <br /> Crystal Bay, MN 55323-0066 Date received: )/—Li f <br /> Street Address: Received by: —1 <br /> 2750 Kelley Parkway �0(. _b� lan review fee: g T <br /> KfsHo�` Orono, MN 55356 I�� <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: 2A50 WEAR, C 2,(1. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes U 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: -4'41 DECKS <br /> State License# BC 636111 Expiration Date: 3/3j/17 <br /> Phone: (cell) 9r-fl..-2_)s- 6 2_66 (office) <br /> Mailing Address: 3500 Viii-s g,RL, L>v N 502- City: pcYwi uT14 ZIP: 55`111-1 <br /> Contact Person: T41 L M v,2-0-1A Applicant is: oneactor / Homeowner (Circle One) <br /> Email and/or Fax: Nit_Q P1-1,miNNFSa . Co,v\ <br /> PROPERTY OWNER INFORMATION: <br /> Name: MARA ozAk 4- NI c,1e--- 6.v 655ey- <br /> Phone (day): <br /> Address: 1-Sr50 - EAR- clP- City: OQo,.1(. 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 /> , <br /> PROJECT INFORMATION: Description of project: 2-� ' /5-X/41 / - c4/ fcuL- a 0-LLl C_- <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply New Construction pSingle Familywith ❑ Residence <br /> il Addition - D Ec-1e• attached <br /> garage ❑ Garage/Accessory <br /> ❑Accessory Building ❑ Single Family with DeckBldg. ❑ Public Sewer <br /> ❑ Relocation detached garage 'C Office/Commercial <br /> 0 Private Sewer 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 <br /> Minnehaha Creek Watershed District(MCWD) ❑ 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.org <br /> - <br /> Estimated Construction Valuation (excluding land) $ 117 oOC) <br /> 1 <br />