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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �� —�� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ������j+� <br /> Street Address:� Received by: <br /> y � 2750 Kelley Parkway Ptan review fee: <br /> `� � Orono, MN 55356 <br /> `qkFSH��� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � ' � ���j +Q �,� <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% • ,_ ,/ ���� Q��� <br /> Job Site Address: �7` 1 <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 availabfe. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � � � � C <br /> State License# (3��,3 ;�S c�� Expiration Date: c9 3 ( 2 <br /> Phone: (cell) �,��g C� 3(� (office) <br /> Mailing Address: �3 r?O Gltr�a A�� City:,scw 4�g� ZIP: �5 37f <br /> Contact Person: � � P-T- e 2 (C e p Q�1 cZ Applicant is: vrt r�a / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���<Qc�nr �v ��� 1?SfZd�l,� <br /> Phone (day): �_� 2 c����� 2 <br /> Address: � �-� p3� i �,C,�, p N L City: r,o � � ZIP: <br /> Email and/or Fax }prY1i1 �� �QdC�• ACV1 <br /> ARCHITECT/ENGINEER INFORMATION: � <br /> Name: j�c, � t� � i�9 ,(�/��((V <br /> Phone (day): G�Z Rgq � ?_ �� <br /> Address: r��_� (���,�_t�i 1 t2q� CitY� �i rt�n1 oa�r��<ZIP: 5��,�,�� <br /> Email and/or Fax: � F.� ��E �F� �,��� , �� ,� <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 /> dJ-t� <br /> Estimated Construction Valuation (excluding land) $ �Q-c� � c� f� � <br />