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CITY OF ORONO 2 (� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OMailing Address: Permit number: C5�O/ctl-�o 7.'3 <br /> 1 VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-/ <br /> Street Address:' Received by: r� <br /> y� L� 2750 Kelley Parkway Plan review fee: (p. <br /> kESHDR� Orono, MN 55356 ���y �- Q"U ;7S <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: I qgS Fo X ST <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 serviceill 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: Crfwo`�,,q o D Crfff&w <br /> State License# I,SCHH 3751 Expiration Date: __3Jst__3J3It. <br /> Phone: (cell) /2 - So)- 37S 0 (office) <br /> Mailing Address: S Cit : ZIP: SS33 <br /> Contact Person: CHS, "rs 4IMS o Applicant is: Contractor / Homeowner (Circle one) <br /> Email and/or Fax: ckr,1�CAM1(c afy cow.. <br /> PROPERTY OWNER INFORMATION: <br /> Name: b)L�L- Ayva <br /> Phone (day): q,.p 0;_-VO-1-646-7 <br /> Address: lygs- fO�C ST- City: 04_60evo ZIP: SS39 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 100D Df515 .l <br /> Phone (day): co 2 - >S'1-109 j <br /> Address: 4o So-14 7 t!' City: PJ(u✓A/CtlYoL-o ZIP: 5"o-2- <br /> Email <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 /> ❑ New Construction Single Family with ❑ Residence <br /> [4 Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial 19 Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may also require ❑ Commercial [2 Other(specify) <br /> MCWD review&permits. ❑ Industrial bei-cam.✓tote d N­w ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) fo tt-j <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.min nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br />