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jAX 1 v CITY OF ORONO <br /> 1 V <br /> A Q , :I <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS �,,y' <br /> A, Mailing Address: Permit number: U I ?Y 00'1(13 <br /> �0� PO Box 66 <br /> 0 Crystal Bay, MN 55323-0066 Date received: (0-4-15 <br /> Street Address: Received by: 114'r <br /> 'r <br /> S 2750 Kelley Parkway Plan review fee: <br /> F L <br /> t Orono, MN 55356 <br /> RkESHo9 $79 3 9 <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: 1 5 0 GO: 1 IOL,,,) U Ls e w 1J`(- ``I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? El 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: L)4 r('/ Q1 So'J CL' o 14ov^r's <br /> State License# V C_ 5 £3O 7 7 if Expiration Date: ' -5/ — / f <br /> Phone: (cell) 16, 3 ag. I -,) L((,D (office) '74, 3- L/7 6. •-COCl S <br /> Mailing Address: • o ` --e,,t,e( _ci kt tv Ci : Pi v+-rtry F ZIP: 55 e <br /> Contact Person: f^14.r r y p f s()Vs.) Applicant is: -on ra / Homeowner (circle One) <br /> Email and/or Fax: lac' fy 01 ScfJ et)14-iS ►1f c,0 ..-. <br /> PROPERTY OWNER INFORMATION: <br /> Name: 3sc,5 4-\-•-•. et• ci-I y 5 5 e' 1'V e- <br /> Phone(day): <br /> Address: /5'0 w - l I o' ' V =r w 0{i''e City: Oro ZIP: 55 3 51.. <br /> Email and/or Fax A , kcx v‘"U t e o i c k 5 '‘ • CO I1,\ <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 NI Single Family with 0 Residence <br /> ❑Addition attached garage 0 Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building 0 Single Family with [2.-Deck <br /> ❑ Relocation detached garage 0 Office/Commercial ❑ Private Sewer <br /> 4 Other: (specify) neck 4a r. 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> "`Any earth movement may also require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> $ v6 <br /> Estimated Construction Valuation (excluding land) 1 r ? O 0. <br />