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CITY OF ORONO / <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: X13— O/OC>/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-006 Date received: <br /> Street Address:' ^�(►IV Received by: ¢ <br /> 2750 Kelley Parkwa �I v' Plan review fee: �p 3 <br /> t Orono,MN 55356 <br /> �kEsH0S O — O/OGp <br /> Total Fe <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 informationli must be submitted. <br /> GENERAL INFORMATION: 0 f+��, <br /> Incomplete applications will be returned. (Please print) � +Y Wv <br /> Job Site Address: 1 '06 n ?c R-t p( fz— <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/APPLICANT INFORMATION: <br /> Name: (�►.y'S7-m� C--f— It,rI <br /> State License# q'-1-? C Expiration Date: 3 <br /> Phone: (cell) 'j(�� 3 L fl (o (office) <br /> Mailing Address: t (0 2 ,1 106 `+ t— city: t,i s ZIP: 5"L $q5- <br /> Contact Person: IA q.R.tt Applicant is" on rac / Homeowner (Circle One) <br /> Email and/or Fax: (k/;, y 3S, 0o'7/ MAI-Jif- 4 S*h-V cA1e1% rc COL)r-Gt , CAyU­'_ <br /> PROPERTY OWNER INFORMATIO : <br /> Phone (day): <br /> Address: 6Z_�i City: opy/V 0 ZIP: _j' :gs—(,, <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _Q S A.+,.1rv1 <br /> Phone (day): q S Z. gq_kp , <br /> Address: `5-1 t?O �,_W/N�4 !AAO 944-0 &ZD/ City: &D//1/4 ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ElNew Construction Single Family with Residence <br /> aAddition attached garage ❑ Garage/Accessory Bldg. 4 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 lffPublic 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.min nehahacreek.or <br /> Estimated Construction Valuation (excluding land) <br />