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, --- -� ,p � � ti�� C"�� �I� <br /> . �� 'V�� U� � <br /> , � i� <br /> , �. � �j CItY OF ORONO 5'�1 <br /> � BUILDING PERMIT APPLICATION 3�� <br /> � 5r <br /> FOR NEW STRUCTURES �R ADDITIONS <br /> �O , ` Mailing Address: Permit number: ��/ ��— � <br /> �irO � `� PO Box 66 � <br /> ��, I 1' Crystal Bay, MN 55323-0066 Date received: - / <br /> �`� StreetAddress:' ��X� �' <br /> � . , <br /> ti L� 2750 Kelley Parkway �(�j—�1,�� Plan review fee: � � � � <br /> `� Orono, MN 55356 <br /> I�KESH�R� ______.._ ' <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � (,�r(M/ CC 1�1�Q - � <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: <br /> Job Site Address: 7(0'� J-2 � �} C.= . v �r/���� i7� <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 service will be <br /> required unless applicant demonstrates 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: celi - ,S- office S .s-OS 3 <br /> Mailing Address: G Cit � ;,,,,��T•..d� ZIP: ,SS <br /> Contact Person: c!f w•�� T��c. s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ��cl,� Q �' �,,o o �1..�-lE �,-LO�w s .Go r� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��p'a .,,,� Bd.ao� D� v . C L C <br /> Phone (day): QS .? - S y�- G S S/3. <br /> Address: G � Cit : .�,..�..� Tw�r'..ZIP: <br /> Email and/or Fax �STc v c.. � C� L�ao .� v;[.�r,�a . Co ��--�- - <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): Z - 3 u � Q <br /> Address: // Cit : ,�,,..� Tv.,.,r,z�P: s 3 y <br /> Email and/or Fax: ^ v Q '� c w's . ...---. <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 ❑ 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 ❑ 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 />