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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: Qr+ <br /> A <br /> 2750 Kelley Parkway Plan review fee: D <br /> SH�¢�G Orono, MN 55356 0-2 D L <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: �r�0 �� (/V I( ,t !''..E <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0N0 <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: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: <br /> PROPERTY OWNER MORMATION: <br /> Name: IN it�l ,g..n n <br /> Phone (day): :9 63 - ?73!i <br /> Address: !fir 5� o t,�Jtr c� L,✓ �rz�tf� City: G� ZIP: s� � <br /> Email and/or Fax ��-, �v«,�,t/ ` • 1 —L `Gc/%7rtlG C-c .t�. <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: C�G1Jn <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> osed Use 3.Structure Type 4.Sewage Disposal & <br /> r Water Supply <br /> le Family with El Residence <br /> ched garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> Ile Family with Z Deck x Z <br /> iched garage ❑ Office/Commercial ❑ Private Sewer <br /> ple Family/Condo ❑Warehouse <br /> c ❑ Storage ❑ Public Water <br /> D Vg mercial ❑ Other(specify) <br /> ;trial ❑ Private Well <br /> r: (specify) <br /> gj <br /> E ) $ <br />