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(..r� �_21- i� <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION �� �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: d�� 0D3�� <br /> � �O PO Box 66 ,/ <br /> Crystal Bay, MN 55323-0066 Date received: 7 - z�-� <br /> StreetAddress:' Received by: <br /> y� G` 2750 Kelley Parkway Plan review fee: <br /> t �, Orono, MN 55356 <br /> AkES H O� <br /> Total Fee: a p��a '�'J <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: i5�? 3 ���ti � ;-� O .�v <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 I APPLICANT INFORMATION: <br /> Name: (Z�� ,�.4�2►� Ci-����s�<� <br /> State License# fyc������r.,i,,i�`. Expiration Date: <br /> Phone: (cell) (office) �S� - 5/7�- �i� � <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �.�-C_tt-rA�ua lc-ts�FC-r+� <br /> Phone (day): 95�-L-l7G��/G� <br /> Address: 35p �3iZc�,-v,✓ �Ze� S�c�r�- Cityp,�:�,,,t;i ZIP: SS3�� <br /> Email and/or Fax �Z f��„i <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �f�,.,/� <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: � /.,� ���` �f <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction �j�� �f�� �Single Family with �Residence <br /> ❑ Addition � attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building Rc����� ❑ Single Family with ❑ Deck <br /> ❑ Relocation s� �� �`j detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other: (specify) iL'1 D��` ❑ Multiple Family/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) $ /y, �IJG� <br /> —7 <br />