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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 /> 0 Crystal Bay, MN 55323-006qDate received: - ` / 7� <br /> Street Address:, NIII Received by: <br /> yF ` 2750 Kelley Parkway 1 ��14 Plan review fee: 0 0 6 <br /> e kEsfio 'i, Orono, MN 55356 v7� 41_ e 9 <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: �35 1�G-Sco yo-/. gog-6 <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 1 APPLICANT INFORMATION. <br /> Name: (=-} <br /> State License# Expiration Date: <br /> Phone: cell O - /- 6,S office <br /> Mailing Address: Ae <br /> Contact Person: X1 Applicant is: CQontra6toO / Homeowner (Circle One) <br /> Email and/or Fax: v� <br /> PROPERTY OWNER I FORMATIO <br /> Name: Q 1 C <br /> Phone (day): ! -12 7 2 - 3 <br /> Address: ZA0 3,5-- C0-560a,,.. - RCA City: ore,(L <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORM TION- <br /> Name: S��r✓��- � =c�✓� LL(— <br /> Phone (day): 7S& <br /> Address: 100 City: (f-7 CE :Q ZIP: �SS <br /> Email and/or Fax: v-� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction Single Family with Residence <br /> Addition 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 ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "Any earth movement may also require ❑ 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) $ <br />