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4. <br /> CITY OF ORONO X01 ` Lk' ' <br /> , , �� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A rO Mailing Address: Permit number: ©2013'C/0/3 <br /> <V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �v�7 �� <br /> Street Address:' Received by: /iit" <br /> .--AS G� 2750 Kelley Parkway Plan review fee: A,. a/O <br /> �i �� Orono, MN 55356 �O/3_6/0/y <br /> kt?S H O <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: 9 L s ii,s qo1/4,.. Q:e.a '1Nnvte-- on,y,0 1"tr'� s S 3 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes g 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: L C cam. <br /> State License# p. _(1,,S 383 Y Expiration Date: `3/31 I <br /> Phone: (cell) '7(43-242(4-2.41.51 (office) 9S2--91.l0-lo$9g <br /> Mailing Address: 2311S n;JS S-7".. City: 1-49A. L,At'_ — ZIP: SS 3St4 <br /> Contact Person: „ Applicant is: t fri1C1 N(.T• / Homeowner (circle One) <br /> Email and/or Fax: i., eS e_..0, 0c'2-x.‘, fIeS.c c,AA— <br /> PROPERTY OWNER INFORMATION: <br /> Name: A,n1..1 A. T.,-_ <br /> Phone (day): 9 S2--t-1 rt 3-2 L b <br /> Address: C7LI'S- W 4lc 11i`t.,-- "hn _ City: .rot At. ZIP: SS 3S-Lo <br /> Email and/or Fax rrfA <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: - t <br /> Phone(day): 9S2-9?t0-(,5<c't C\ <br /> Address: 23ctS 1�,--�Ig „S4,-=-�- City: £.o� Lake_ ZIP:.SVage <br /> Email and/or Fax: al ti4-- Q.,.3,,.. 4vtti <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 a Single Family with IS1 Residence <br /> E Addition attached garage ❑Garage/Accessory Bldg. ®Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Deck <br /> ❑ Relocationdetached garage 0 Office/Commercial ElPrivate Sewer <br /> 'Other: (specify) 1 ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage 0 Public Water <br /> **Any earth movement may also require LI 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 /> c7 <br /> Estimated Construction Valuation (excluding land) 2_1(d <br />