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� CITY OF ORO O � g � • � D <br /> , � <br /> BUILDING PERMIT AP LICATION <br /> FOR NEW STRUCTURES R ADDITIONS <br /> O Mailing Address: Permit number: 0�3 -DD ss <br /> PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: lP a �`�-� <br /> StreetAddress:' Received by: <br /> y� � 2750 Kelley Parkway Plan reviewfee: �0�3 - <br /> ��,�' Orono, MN 55356 �lS-- <br /> `9KFSHO Total Fee: �`S� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.oron .mn.us <br /> This application form must be completed in full and all re uired information must be submitted. <br /> Incomplete applications wiil be retu ned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: � ' G�� j� �� � C,�1 y`� f <br /> Will this be a Parade of Homes, Remodelers Showcase Home o other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council appro al 60 days prior to the event. Shuttle bus service will be <br /> required unless appficant demonstrates su�cient on-site parking is available. Non-perm ed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: t�(� l;�-'/'�' "` G'�) _`� V C�..� ;� <br /> State License# S 3 Expiration Date: -� �� � <br /> Phone: cell d• � -- �� o ice <br /> Mailing Address: C -� � -n, � � 'r� Cit : ZIP: - <br /> Contact Person: riU l c. � Applic nt is: n ractor �/ Homeowner (Circle One) <br /> Email and/or Fax: �U � �� � � �� (JIA.l f�,' G � <br /> , <br /> PROPERTY OWNER IN ORMATION: <br /> Name: ' � �E -� �'�-- <br /> Phone (day): ,� � - — � <br /> Address: � '��� �LC� � Cit ,� � �" ZIP: � � � � , <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <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 /> 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 /> Estimated Construction Valuation (excluding land) <br /> $ ��a �' <br /> � <br />