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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> '���`� Mailing Address: <br /> ' O O� Permit number: o����J'� <br /> / � N' Po BoX ss <br /> Crystai Bay, MN 55323-0066 Date received: ""�� � � <br /> �. ; ' , StreetAddress:' Received by: <br /> '� � 2750 Kelle Parkwa <br /> ' ! 1� ��'' Y Y Plan review fee: <br /> f Orono, MN 55356 <br /> �9K�\H�?�,/ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 - <br /> This application form must be completed in full and alI required information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORMATION: ; <br /> r= <br /> Job Site Address: '��,r--cJ�� l'`�z��c�S � ����f' ;�����G%��E� .5.����1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> requir�d unless applicant demonstrates sulficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: . <br /> Name: --J��� V _.� � ! K � <br /> State License# Expiration Date: <br /> Phone: cell o�ce <br /> Mailing Address: F' -��--c�1' `` Ci : ZIP: '" ' <br /> Contact Person: Applicant is: Contractor / ome� (Circle One) <br /> Email and/or Fax: ' � d ���� <vLtct� �- � C a �(, <br /> � <br /> PROPERTY OWNER INFORMATION: / <br /> Name: v- F—� � � <br /> Phone(day): / ��4' �4/ <br /> Address: �� —� .�� 1" � v Ci : , L, � Zlp: -''' <br /> Email and/or Fax � y'y (�����C�i L , Co e�/L <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal8� <br /> Water Supply <br /> j�Ale�.G.Qnstruction �(Single Family with �Residence <br /> �.P�dtfltion attached garage ❑Garage/Acoessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑Relocation `1 detached garage ❑Office/Commercial ❑Private Sewer <br /> �Other. (specify) �c�►'��:�L ��(.�N/�i ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (Sp2afy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wv,na.minnehahacreek or <br /> ` <br /> Estimated Construction Valuation(excluding land) $ � l ����� 'J" ���Q <br />