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CITY OF ORONO � d, <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS j <br /> �O1V Mailing Address: Permit number: <br /> o PO Box 66 <br /> Crystal Bay, MN 55323-0066c Date received: <br /> Street Address: �V Received by: � d lC� <br /> y 2750 Kelley Parkway 1 I1 Plan review fee: a C E Orono, MN 55356 i I� <br /> SHO�� 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 �,. ,�,' So t„ 6 b0 o l�l S-57 31 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes XINO <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 i APPLICANT INFORMATION: <br /> Name: go �3 V LQ q rtiCu <br /> State License # g (ovi &pq-k Expiration Date: 3 3/ /a,0 Ic <br /> Phone: (cell) C,12- z70Ga/y (office) SG <br /> Mailing Address: P,p /3 x qj City: cycfts;ov- ZIP: t <br /> Contact Person: 5,e+c, h Applicant is: on ract / Homeowner (circle One) <br /> Email and/or Fax: 5Z4- (,,.,_ ,Ne1 �? (ec at�i bn�'l .rs co v►. <br /> PROPERTY OWNER INFORMATION: <br /> Name: �t>,,d g•►,� f/�w.1•� Ktvy►, 'les <br /> Phone (day): �I�— GAG 7— flCo SG <br /> Address: 1000 Wl''tilow Q���� so�lt, City: 6�0 ,,o ZIP: J 3 q _ <br /> Email and/or Fax - <br /> ARCHITECT / ENGINEER INFORMATION: <br /> Name: S54 K$m <br /> Phone (day): j�p <br /> Address: lS-0 Sowk-., ar�,�t�„ City �ayi wFvi ZIP: S—�3�� <br /> Email and/or Fax: r5 Yh S-VeLien Q) 5a.+t.rt Co W\. <br /> PROJECT INFORMATION: Description of project: ou14 `ova wli L)0C, ,eZ <br /> 1.Type of Project 2. Proposed Use 1 3. Structure Type 4. Sewage Dispogal & <br /> Water Supply <br /> ❑ New Construction Single Family with 9 Residence <br /> (Addition attached garage XrGarage/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 ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may also require I ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial ❑ 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 /> Estimated Construction Valuation (excluding land) q00 00 0 <br />