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6.-'VLct Lei., 4/3 <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS nn�� <br /> �O VO Mailing Address: Permit number: ab,�-1)(��p/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ;�o-�}�—(3 <br /> Street Address:' Received by: <br /> - 2750 KelleyParkway y� Plan review fee. <br /> �' Orono, MN 55356 <br /> `�kESHO�� 78.5/% <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: C3/ 2S Gt,�.Age, 2 4 S C-f217?Cf3i'vo, i•-.,,,, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 3-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 ORMATION: <br /> Name: So,s" k v -t Z Ze" 441‘'PSc.4r....65 4 S'/ <br /> State License# ,'j' ' 5,' 'j <br /> ' Q Expiration Date: ,--?/3! /-dz/ - <br /> Phone: (cell) 7G3_ G'g _ r2/7 (office) fS '- 303 31r7f <br /> Mailing Address: 7 qo '?TK*-AZ City: Qec. p ZIP: s--s-3�3 <br /> Contact Person: Sop.+ eg=he.i.+, .-C Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: do,eer„ 4�,4-s 44•vj2s ,q,14-s 7'4=^. <br /> PROPERTY OWNER INFORMATION: <br /> Name: L',4/Cis 41-/li,4 t / l't,Q^./0 f <br /> Phone (day): 9So2-y ' Sr- Y&V 4 <br /> Address: p?/77- i.rE-ArzfeA, «.._- /gyp City: se>to._ro, ZIP: S-'c-34W <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: <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 /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with "lieck <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) r �j0 <br />