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..-f 5029 <br /> `f CITY OF ORONO 1344, 53/ 75 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ? p <br /> O Mailing Address: Permit number: 600/ - O 25- <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006; i Date received: 8—ZO_13 <br /> Street Address:' , / Received by: 13 <br /> 2 2750 Kelley Parkwayuuu" q I �j� 6- <br /> Plan review fee: GLS 787`. 3 q <br /> ""- I <br /> e4ktSNo„ Orono, MN 55356 a6/3-' '6'62-r/ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us V Pildid e 40/1 aar ' rel' <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: X70 W; `yl ourtoC Lano_ <br /> Will this be a Parade of Homes, Remo eters Showcase Home or other Display Home? ❑ Yes 1 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: ..11Srtyni-Vy C�s4�►„ 3 0'1Icl,-s Ll..C. <br /> State License# 8C-6a7 f Z.7S Expiration Date: 3- lc-i S <br /> Phone: (cell) L/Z_-."St,") -3;9_5 (office) <br /> Mailing Address: ''nolo P'nlali-; L-1,--w City:\pit\ ,7r-�k. ZIP: Ski2,9I <br /> Contact Person: .k,j,„ j),Ii,n Applicant is: n rac___ / Homeowner (circle One) <br /> Email and/or Fax: j/�_1" <br /> lr'1 ,e,IY1in4„sS-)•„» 60. i♦d,f,.,, <br /> PROPERTY OWNER IN,ORMATION: , <br /> Name: 3.�-�^,h i4 t- <...7�` :-ri Of L. '; LLC.. <br /> Phone (day): Cr.,/Z--4- c- 2S <br /> Address: 3'D10 5 1-440- City: r,�e,�,7a�� ZIP: 53-3c1/ <br /> Email and/or Fax -oh o,in gin; ,Jm b.3 i Jc rs -e..Arvi <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: L,4.or1J i, �.1 i.yz. <br /> Phone (day): - - ' , _ <br /> Address: 393L-1 3`-) Lt_ci.,C --n Ave- Int . City: ZIP:55/ (� <br /> Email and/or Fax: J ce; <br /> ,r , -1�y- - rs,,,-, ry e:v Z <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> .f New Construction 51 Single Family with al Residence <br /> ❑Addition attached garage 0 Garage/Accessory Bldg. ® Public Sewer <br /> ❑Accessory Building 0 Single Family with ❑ Deck <br /> ❑Relocation detached garage 0 Office/Commercial ❑Private Sewer <br /> E l Other: (specify) 0 Multiple Family/Condo ['Warehouse <br /> ❑Public ❑Storage [' Public Water <br /> **Any earth movement may also require ❑ Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ 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.orq <br /> $ <br /> Estimated Construction Valuation (excluding land) i:Df , <br />