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L�N�,� <br /> �: �7 <br /> � <br /> �� � � — <br /> , CITY OF ORONO ��', ��f <br /> BUILDING PERMIT APPLICATION ��,� �,1`�01��'l <br /> �y t <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���0 MailingAddress: Permit number: �C' � S " �'C s � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 1 - z3 "1 S <br /> � � Street Address:� �• -Received by____��_� �� <br /> ti�, � 2750 Kelle Parkwa C��� cj-� �c� �� � --- ._ . '��( <br /> � Y Y � C� Plan review fee: .,�• <br /> �' Orono, MN 55356 � � �✓ � <br /> `qxFSH�R� _ __ . _. _.--__------ --_ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � ( — S� � <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: n <br /> Job Site Address: � �j , ,' � C.� , J 7 r�� '�`�`�; ` � •r <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: ' [ -� <br /> State License# � Q Expiration Date: 3 3 Q <br /> Phone: cell - - s" office S - 3 .s'OS 3 <br /> Mailing Address: G Cit � ,,,,,..�T'•..2�,o ZIP: SS <br /> Contact Person: c/�w•�� T�w s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �7'/Gc�,� Q �.' �,,,,o o �..+-/E u,-LD�«� s .Go� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �ro ,,.,� fja.a,oiC, Dc ✓ . C C C' <br /> Phone (day): QS .? � S y�— G S Si 3. <br /> Address: (, 7 � Cit : .�w� j.,.,.n'..ZIP: ,s <br /> Email and/or Fax � Te v � G Ci l.�ao .� v,�L.s��,u • L'o �-•-- - <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: "� <br /> Phone (day): �. — 3 u - p <br /> Address: // Cit : ,;...,....� 7"v...,r.,��P: s s 3 y <br /> Email and/or Fax: ^ v Q �� c �.i .G �-�-, , <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 0 Single Family with ❑ Deck <br /> ❑ Relocation �ci�he� d qarage ❑ 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) $ J� Q a Q Q • <br />