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.��-� <br /> " . . <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A � Mailing Address: Permit number. 2a ��— <br /> 1Y� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: -- / <br /> ,� Street Address:' �I1 • <br /> y�; G� 2750 Kelley Parkway ���—t�� plan review fee: � � <br /> t,���s�o��, Orono, MN 55356 <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: '�(o� j"Z �� �- C.� ; � 7Tf,���i/?�'. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus seivice will be <br /> required un/ess applicant demonstrates suffcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I MATION: <br /> Name: ' L t <br /> State License# � p Expiration Date: 3 3 � <br /> Phone: cell - ,g- office S ,s'OS 3 <br /> Mailing Address: Cit � ;,,,,..�T,..�� ZIP: S"' <br /> Contact Person: c�f,�.,.'e 7"e�ti 's Applicant is: Contractor / Homeowner (Circle One) <br /> Emaii and/or Fax: $7zcJ,� Q �.' o n �..,-/E �,-LD�ti s ,Go ra� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �T'o.�.� B,�t.aciC D� v . C L �' <br /> Phone (day): QS .? � 3 y 3�- G S y 3. <br /> Address: G 7 Cit : .�,..µ.� Twlr«ZIP: ,s' <br /> Email and/or Fax ��Tc � G � B„ (,�,9 ao .� ,�;��.�� Ca »--- <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: '� <br /> Phone (day): 2 - 3� . Q <br /> Address: // Cit : .r-,,..� 7rv.�,.,�",rZIP: f ,3 y <br /> Email and/or Fax: '- v �. '� c w s . ...�. <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> New Construction Water Supply <br /> ❑ Single Family with Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. � Public Sewer <br /> ❑ Accessory Building 0 Single Family with ❑ Deck <br /> ❑ Relocation ched arage ❑ Oifice/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) [�ulti le Famil Condo ❑ Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> Minnehaha Creek Watershed District MCWD ❑ Prlvate Well <br /> ( ) ❑ 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 d Q Q , <br />