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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: vk)/ 1-(5,0y307 <br /> Crystal Bay, MN 55323-0066 Date received: —/ ^'/7 <br /> Street Address:' Received by: /� <br /> T <br /> 2750 Kelley Parkway Plan review fee: - <br /> Orono, MN 55356 / • 4,:3 <br /> Ff.SHO CLS, <br /> Total Fee: ci <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 o'. W 1 l a w 6k <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes NI o <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.e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: M ryr,L w t DC. q <br /> State License# Expiration Date: <br /> Phone: (cell) (office) 93 - `i 7 3•—i 2 t s <br /> Mailing Address: 10,1,1 w: 110L01)..-, ,I. J,- City: c>4*tt,„c, ZIP: 5,5- <br /> Contact Person: Applicant is: Contractor / eowner (circle one) <br /> Email and/or Fax: 1,v)43.1-K. L , i,w -1"1" y c tno <br /> PROPERTY OWNER INFORMATION: •1 <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <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 /> 0 New Construction El Single Family with El Residence <br /> RAddition <br /> - <br /> RAddition attached garage ■ Garage/Accessory Bldg. El Public Sewer <br /> El Accessory Building El Single Family with .gDeck <br /> ❑Relocation detached garage 1=1 • ❑ Private Sewer <br /> E l Other:(specify) ❑Multiple Family/Condo El Warehouse <br /> ❑Public ■ Storage ❑ Public Water <br /> **Any earth movement may also require El Commercial ■ Other(specify) <br /> MCWD <br /> - <br /> MCWD review&permits. 0 Industrial El 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.or• <br /> Vv <br /> Estimated Construction Valuation (excluding land) 1500 <br />