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�► (� <br /> ` �' � L <br /> � �� � � � � <br /> . C� �a <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: � <br /> O PO Box 66 , / <br /> Crystal Bay, MN 55323-0066 Date received: ���7—/7' <br /> StreefAddress:' Received by: � <br /> y � 2750 Kelley Parkway Plan review fee: � — � � <br /> F � Orono, MN 55356 <br /> 1�'FfSH��� Tota��ee: /O3 7.�� <br /> Main: 952-249-4600 Fax: 952-249-4616 �r��v�..��� t�r�n�.;`����n u�, <br /> This appiication 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: � Z �. h !.�h ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes,a specia!event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service i!I be <br /> required unless applicant demonstrates sufficient on-site parkrng is available. Non-permitfed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,;� ��'! ,/f��� �-C<C� <br /> State License# ��,,�/ o.- '� O¢ y Expiration Date: � i <br /> Phone: cell o ice <br /> Mailing Address: 7 '�^%: T Cit � u r� ZIP: ` Z 7 <br /> Contact Person: O O Applicant is: ontr tor / Homeowner (Circle One) <br /> Email and/or Fax: �.•t ,.- ,� C �t,� <br /> PROPERTY OWNER INFORMATION: ^�/ � ` <br /> Name: p N� t�c 6 , <br /> Phone(day): .? 6 y b K �, <br /> Address: � , Cit : �✓1 � ZIP: �j s y`�6 <br /> Email and/or Fax .4 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ,��?��E.�r�f ���,/��' <br /> Phone(day): � �. <br /> Address: r 7"O t•t. L n Cit : �K ZIP:,� ,�j Z <br /> Email and/or Fax: • <br /> PROJE"" '-•----- <br /> 1.Type c � �d 3.Structure Tppe 4.Sewage Disposal& <br /> }� Water Supply <br /> �New C � /: � � h �Residence <br /> Additic � ; Garage/Accessory Bldg. �Public Sewer <br /> ❑Acces / O 3 � �� th ❑ Deck <br /> ❑ Reloc� e ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: / � 2 g � Condo ❑Warehouse <br /> .J '�Storage �Public Water <br /> ""Any eai � ❑Other(specify) <br /> MCWD re �2J ❑ Private Well <br /> Minnehaha <br /> 18202 Minr �j �� Ul� L- <br /> Deephaver 1 �- <br /> Phone: 95: <br /> Fax: 952-4 <br /> VUn\nN.Rll4lllt. <br /> Estimatec � � <br /> ��� . <br />