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CITY OF ORONO4 0D <br /> BUILDING PERMIT APPLICATION 3 q <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �OW <br /> Mailing Address: Permit number: (X!3 "0/O/ 5 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /0 -/ 7-/..3 <br /> Street Address Received by: � <br /> * 4 2750 KelleyParkway Y Plan review fee: �9 aql�'`� Orono, MN 55356 �0/3 -0/O / T <br /> kESH� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us a;q'f/.d'f rWel (p•LY.I3 <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: 0 f O / ✓`//or.✓b eoo E Or, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ 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: f`i^rc,'S,'cf N+ Pee k s ( Eob 3qn ,' <br /> State License# EC $$3Oa _ Expiration Date: 3 -- // <br /> Phone: (cell) '7'3-- ag.yl./0? ci (office) 763-- 35-5-- S—,..? 5'3 <br /> Mailing Address: . , . . -/ /Y- V Cit : ZIP: <br /> Contact Person: &a Applicant is. Contracto j Homeowner (Circle one) <br /> Email and/or Fax: tob 9 ( --(rck-s. c o ,.s-) <br /> PROPERTY OWNER INFORMATION: I? <br /> Name: i1 x± 4 -- / `iciq pe A, ie / a-- p WRIT <br /> Phone (day): 01.5a. - c/5-1 1776/ `J <br /> Address: 1101 I,U.'/low- broo IC Or City: O (0 Pt O ZIP: S •?g 7 <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 /> El New Construction Single Family with ❑ Residence <br /> IFAddition 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 El Warehouse <br /> - El Public ❑ Storage El Public Water <br /> **Any earth movement may also require El Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial Por'c !'l ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) p 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 /> Estimated Construction Valuation (excluding land) $ .0 C <br /> r <br />