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_ •_ _`.A , � ��� � �7 <br /> � �� �J�z ,I� <br /> CITY OF ORONO , �, s � �3-�'� <br /> yj �� � <br /> BUILDING PERMIT APPLICATION �f►^� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: �v/�,_�� <br /> �O�O PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: l-� z�—/� <br /> � � Street Address:' ^- e • � � <br /> fi Gti 2750 Kelley Park y . �.� �M�-�I Plan review fee: <br /> �.qK�SHo�� Orono, MN 55356��' ( � "� C <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. (P/ease print) <br /> GENERAL INFORMATION: x � <br /> Job Site Address: ?(�,� �o j 3 ,8��` �' �. C,,t ,' v 7%/y,qD0,7'.0,,, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> lf 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 demonst�ates sufficient on-site parking is available. Non-pe�mitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I MATION; <br /> Name: - � � <br /> State License# � p Expiration Date: 3 3 <br /> Phone: cell - - S office s' - s'OS 3 <br /> Mailing Address: Cit � „�,,.�T•_?,,4 ZIP: SS 3 Y <br /> Contact Person: c%/w•��T<<c, s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax. ��v,� � � �,,,�,e �Q„�,/� ,�GO�.,, s .Lo r•" <br /> PROPERTY OWNER INFORMATION: <br /> Name: �J'o.,.� B,d�aiC D� v C L C' <br /> Phone (day): QS � ^ S 5�,�-G,S 5�3. <br /> Address: 7 � Cit : <br /> •v-we Tor-�'-�ZIP: <br /> Email and/or Fax .ST� v � r Cz L�t ao .� ;�r,�w Co �--- <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ^ <br /> Phone (day): �. — 3 � .. Q <br /> Address: // Cit : ,�,,..� <br /> Email and/or Fax: -- v Q. •� � „�,s �� ��IP� s 3 y <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) [✓��� ❑ Warehouse � Private Sewer <br /> ulti le Famil /Condo <br /> ❑ Public ❑ Storage Public Water <br /> *�Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review& 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) $ 3� Q a Q Q , <br />