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/ <br /> /- CITY OF ORONO i � <br /> � BUILDING PERMIT APPLICAT�N Q��/J <br /> ; I <br /> FOR NEW STRUCTURES OR AD ITIONS <br /> �O • O ailing Address: <br /> 1�� � PO Box 66 Permit number: �d�S� <br /> Crystal Bay, MN 55323-0066 Date received: 7'o� � ,5 <br /> -i \� Street Address:' 2_ �eceived by: <br /> ''�% t':1�Y��� <br /> ti�, GZ � \�,n�. 2750 Kelley Parkway d �Li Plan review fee: 9�. � � <br /> 1�kfSHO�� `�\v Orono, MN 55356 � �(�7 ���Jc-_ � �,� � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 3 <br /> This application form must be completed in full and all required information mus be su mitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: �� �� J� <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 approva/60 days prior to the event. Shutt/e bus service �ll be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC NT INFORMATION: <br /> Name: �.�,v� ��n , l.L C <br /> State License# �O�- Expiration Date: <br /> Phone: cell }1 office <br /> Mailing Address: (- F- � Cit : � 2�,1� ZIP: `i53�1 I <br /> Contact Person: (�� �t o. Applicant is: ontractor,' / Homeowner (Circle One) <br /> Email and/or Fax: �� j �dn . 'Gt� �� <br /> PROPERTY OWNER INFO.RMATION: ` - � <br /> Name: � �1C�f I� CL\} J 1 `, �� �1x� <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 ,,,r��-Ci�L f ❑ Single Family with ❑ Deck <br /> �Relocation (� detached garage ❑Office/Commercial ❑ Private Sewer <br /> Other: (specify) IL�����--�1'n� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *'Any earth movement may also require ❑ Commercial ❑Other(specify) <br /> MCWD review 8�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 />