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� CITY OF ORONO <br /> ' BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: q��/,j� <br /> PO Box 66 // <br /> Crystal Bay, MN 55323-0066 Date received: �7-o� "' ,5 <br /> Street Address:� eceived by: __!� <br /> � � 2750 Kelley Parkway .� �G� Plan review fee: 9�. � � <br /> . <br /> `�l,�k ��,� Orono, MN 55356 �i ��� ���5 � <br /> fSH� <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: G� <br /> Job Site Address: �? I �* J`�, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes , No <br /> lf yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service ill be <br /> required unless applicant demonstrates sufficient on-site paricing is availab/e. Non-permitted events will not 6e allowed. <br /> CONTRACTOR/APPLIC�NT INFORMATION: <br /> Name: �C v� ��r� LL C <br /> State License# ���. � Expiration Date: <br /> Phone: cell 1 office <br /> Mailing Address: ( F. a.Y.,e, Cit : Z - ZIP: �i5 3�1 I <br /> Contact Person: (�� vt< �. Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: �' i �pn -ON� �-'�"� <br /> PROPERTY OWNER INFORMATION: �/� <br /> Name: � I�1Gf �i2 (.�1/�} .J 1 �1 I' 11`� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 ,,,��-���e(' ❑ Single Family with ❑ Deck <br /> Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> , Other: (specify) ��1'�Q��-�1'n�'1 ❑ 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) $ � � � ��� <br />