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' CITY OF ORONO <br /> • BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> a �O� Mailing Address: Permit number. p�13-�� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �f- p2./� <br /> � <br /> Street Address:' Received by: <br /> y�, � 2750 Kelley Parkway Plan review fee: <br /> �' Orono, MN 55356 <br /> t�'FESHO�� <br /> Total Fee: <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 information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> ' GENERAL INFORMATION• <br /> Job Site Address: � "�S� �`�5 I (J'� � _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �a <br /> /f yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e 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 INFORM� <br /> Name: ' <br /> State License# Expiration Date: <br /> Phone: cell office 6 --y -� 70� <br /> Mailing Address: S t S � �S Cit : ZIP: <br /> Contact Person: �,,,r�(�� A icant is: on ra r Homeowner (Circle One) <br /> � Email and/or Fax: <br /> PROPERTY OWNER INFORMAT�(I N: <br /> � ��,,/kt,�,: fvl � ! Z �- � �7 - � �6� <br /> Name: <br /> Phone da __ .___ —_ <br /> _�)� _L - 3__ �Z -- _ c <br /> � Address: � 3� (� ,S;�� �D City:C�x.c�r->U ZtP� � J��� <br /> Fm^il ^nrJ/nr C <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> : Phone(day): <br /> = Address: City: ZIP� <br /> � <br /> Email and/or Fax: <br /> � PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ; �Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> � ❑Accessory Building ❑ Single Family with ❑ Deck <br /> y ❑ 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 8�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) $ ,�Z.SC.�� <br /> . _ <br /> � �r� - �,�,q� . . ; .� - ,�� �e' �,�,<, � ,,.,. . . ,:... <br /> , ,.. <br /> , _ .. , _ , <br /> . <br /> . ; <br /> �� =� 3.� 'i - X, <br /> '+'- .. `-_- .F <br /> �z.:a � �` .. S. . 'm. . .. . . _. _ a. . . ., . . =� . . ... ��. .�. ._.... <br />