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� � CITY OF ORONO � 5g c� , 2� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: G�} � -C�' % �� <br /> PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: � '��` ��� <br /> __.--• . <br /> Street Address:� ��" � � q�' <br /> y � 2750 Kelley Parkway ��3 a� Plan review fee:20 - � �� <br /> `� �� Orono, MN 55356 `� <br /> `�kFSH�R� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �sc�au� d <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: ,� (,t� <,�_�.�l ���e l��e, �r V�.� ,� /,hti , <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 INFORMATION: <br /> Name: f)�s��,��, � ��, <<� � �.rc <br /> State License# /j�' �.,3 �7 � �, 'L Expiration Date: C s�cr; ! 2 c�rS <br /> Phone: (cell) (�. (2 3 � 3 (? � � (office) <br /> Mailing Address: j ". � S ...,•� ,-.�il yi. Cit : L��,-�;;!� ZI P: .��s'v �Y <br /> Contact Person: �'� � C r�;1 Applicant is: .ebn rac�/ Homeowner (Circle One) <br /> Email and/or Fax: �'r -� � ��' c��c�� .� r o,-- _s. �t; 4� �=, < - � , ..-, ` <br /> PROPERTY OWNER t�IFORMATION: <br /> Name: Ll��,,_i;; . /� ; !/��._ <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: � U��^G��(Ql.�l.� � <br /> Name: �U��U� W1U�(�✓� �J S�11��1'1'J�WJ ��lCl�� <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of 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 detached garage Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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) $ �a� ���, � <br />