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, 0 k 3 4 Cp 3-5 <br /> CITY OF ORONO / Cjapt,, <br /> iJ <br /> BUILDING PERMIT APPLICATION 12(,l-k' Il <br /> FOR NEW STRUCTURES OR ADDITIONS ri- <br /> �Of VO Mailing Address: Permit number: o)o/3-oligif <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: (1-5-13 <br /> Street Address:' Received by: �os <br /> 1* 2750 Kelley Parkway Plan review fee:Ft1'�FSHo�,G Orono, MN 55356 a0/3—O//g 3 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 55crow A.c! ( (L•tj,,(3 <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: 230o Wi llol, Ail Dr. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? X 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: FtMitt 44on'ec <br /> State License# -19230s Expiration Date: <br /> Phone: (cell) bf -4‘10-7130 (office) g52-4-04-1204- <br /> Mailing Address: I i cut , , 1 Ket. safe (08 Cit : ,c+a ZIP: Com(( <br /> Contact Person: 4 -_l_ Applicant is: Contra for / Homeowner <br /> ll (Circle One) <br /> Email and/or Fax: rick®kehJeI"c"tes.Cop <br /> PROPERTY OWNE INFORMATION: \I <br /> Name: �tti� gall ir a her-jai <br /> Phone(day): 244n -ti oroujI4 red (ane, <br /> Address: J City: Ofq(to II,/(0 ZIP: 553510 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION �l� <br /> Name: Rork tire c -lt.IS s <br /> Phone(day): 01-342- 127 <br /> Address: 2219 t.t City: A t(WAZIP: 55-o22 <br /> Email and/or Fax: Yongfc.ofs coot <br /> PROJECT INFORMATION: Description of project: _ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> jg New Construction I..Single Family withResidence <br /> ❑Addition attached garage 0 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. ❑ 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 /> C' 9— <br /> Estimated Construction Valuation (excluding land) $ `� ( OD. <br /> f <br />