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tkic ILI/ <br /> , i <br /> a•k51i L4 <br /> CITY OF ORONO AUG 2 77 <br /> BUILDING PERMIT APPLICA ION Cfly0F 014 <br /> FOR NEW STRUCTURES OR ADDITIONS ORONO <br /> -szL0 � Mailing Address: Permit number: O,2 DI -' Do?b p <br /> PO Box 66 p p <br /> Crystal Bay, MN 55323-0066 Date received: 7/i Y <br /> Street Address:' L• <br /> �. Received by: <br /> y 2750 Kelley Parkway �IblI''`" Plan review fee: 49 7 7 <br /> F c., <br /> ttkesxo�� Orono, MN 55356 p <br /> Total Fee: c:70/(/—GZJ` <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: 364 C,S-i- I—&ke +(ee,-1- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes is.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: VCA-IIP 7 POO/5 Otho Spa.5 <br /> State License# Aiiiii Spa.5 <br /> Date: <br /> Phone: (cell) 6)2.• ;13- 5V473 (office) 93-e 8 99-/i7/5,0 X/W) <br /> U <br /> Mailing Address: 36 j Eu5 C/)q _ City: 30,175 frit if ZIP: .55337 <br /> Contact Person: /�an dy Ail 04 -, Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: roLt1,irr., &)'✓c�..//t�,r'?O /s. thy, `lj'1- B9//,.. !/f3K -- <br /> PROPERTY OWNER INFORMATION: <br /> Name: M i Ke and Jr:rre1f SA,. /ds <br /> Phone (day): 95,2- 41 3-- 6132 <br /> Address: City: ZIP: <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 ❑ Deck <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. aIndustrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) 4 Other: (specify) <br /> 18202 Minnetonka Blvd Sw;, )h, rezi <br /> r, <br /> Deephaven,MN 55391 r✓j <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 0/5-00C) <br /> 1 <br />