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CITY �F {�RONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: ��S�d0�� <br /> �' �O PO Box 66 . / � <br /> Crystal Bay, MN 55323-006 Date received: �v — c3 ' <br /> � � StreetAddress:' Received by: <br /> F G� 2750 Kelley Parkway 'A� l�� Plan review fee: <br /> ��kESH���. Orono, MN 55356 �"`� 7I� � <br /> Main: 952-249-4600 Total Fee: �9, Q 7 <br /> Fax: 952-249-4616 ��;;•, ; ,� ;. ;s <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications witl be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2C�G' ����Stc��' ��<< r� ; �i/U�^�, /I�� -S^'--�;5'J/ <br /> Will this be a Parade of Homes, Remodelers Showcase Hbme or other Display Home? � Yes ❑ No <br /> If yes, a special event pem►it is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service wi/!be <br /> required unless applicant demonstrates sufficient on-site parking is availabfe. Non-permitted events wil!not be aflowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: L<<v►c�S�,,�e� �-(v�1�w��f�G'� <br /> State License# Expiration Date: <br /> Phone: (cell} ��SG �- j��j (o�ce) ���.- ZI(n-Z�'� <br /> Mailing Address: 3Z I ,�,�,d�.•��, y �¢✓,� City: �'�,;.�t �- ��,� ZIP: .�G�/ <br /> Contact Person: � ��,�,e� Applicant is: Contractor / Homeowner �c���e o�e� <br /> Email and/or Fax: ;Y�, � /,�--H y«ypr�u��,��t�d n�rN�c�c��-i, <br /> PROPERTY OWNER INFORMATION: <br /> Name: (��i►`�c� /�p-�,r.S <br /> Phone (day): ���_ •�y� _ ���j�q - �f h�:r► <br /> Address: (c.r�Z i'�/sor,_�1�...��..-;ti l N�� `�1,.....<<Y City: C�;ldr�� ��//��IP:._.�J S'ZZ <br /> Email and/or Fax <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: CJ'►-ffv',�,l��t - �" �i r�/jG�vf'�i t��) ., 2 e✓'S <br /> Phone (day): - 4 ,� ' <br /> Address: �.vi � Cit : � v,�+��� ZIP: /�/� <br /> Email and/or Fax: � ,;' ', �.r,.,,. � _..,<< ; - �-l.ti <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> ,..,� Water Supply <br /> �New Construction ,�Single Family with ❑Accessnry Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence .Q(Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family!Condo �Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "'Any earth movement may alsa require ❑ Commercial ❑ Storage <br /> MCWD review& permits. ❑ Industrial ❑Warehouse �j Private Well <br /> Minnehaha Creek Watershed District(MCWD} ❑ Other: (speCify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> - -a,, :a� <br /> Estimated Construction Valuation (excluding land) � � ��j � <br /> t � <br />