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^___ _��, � <br /> . CITY OF ORONO � � <br /> , <br /> , BUILDING PERMIT APPLICATION �� <br /> FOR NEW STRUCTURES OR ADDITIONS � <br /> Ooagg <br /> �O A „O Mailing Address: `� ��� <br /> 1�� PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: �j <br /> y � Street Address:' Received by: � <br /> F ti 2750 Kelley Parkway <br /> �qk�.S�o�,�.L Orono, MN 55356 Plan reviewfee: ! ? . <br /> C�lS- OG�B' <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �5 <br /> This application form must be completed in full and all required information must b submitted. �� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �a��t <br /> Job Site Address: �D/ s� � �� � C� �. v �/�����T.�o..-, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> lf yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonst�ates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I MATION: <br /> Name: - � t <br /> State License# � p Expiration Date: 3 3 <br /> Phone: cell - - S office S .s-OS 3 <br /> Mailing Address: Cit � „�,,,.�T,_?,,� ZIP: S' <br /> Contact Person: cl�w•��T<<c s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: cl,� �' u:LD�ti s , o�.•�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �To,,,� 6,d�,a D� v CL <br /> Phone (day): QS 2 ^ S S�.�'- G s S�3. <br /> Address: <br /> Email and/or Fax �T� � � r Q, Gyao ,� y �� �City: a.'�� Twrr..ziP: ss 3 y3, <br /> -� d. <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: ^ <br /> Phone (day): �. - g u . Q <br /> Address: // Cit : ,�,,..� <br /> Email and/or Fax: Q Tv..,t.rZl P: j' ,3 y <br /> �L � w 3 . w�-� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type 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 hed arage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ulti le Famil /Condo ❑ Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> '''`Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8� permits. ❑ Industrial <br /> ❑ 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) $ �� Q d Q Q . <br />