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� <br /> � � � <br /> � � � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: permit number: p�Q/�D C�oZ/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Reeeived by: � <br /> y�, G� 2750 Kelley Parkway Plan review fee: ��/��d � <br /> ��, Orono, MN 55356 9Q8 �,,� <br /> `�k�SN� Total Fee: � ' <br /> Main: 952-249-4600 Fax: 952-249-4616 �r�vv� ci oronc`rr�nYu?: <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: � G�1� d C-G"�T�'� ��'�'� <br /> Wiil this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parkrng is availab/e. Non-permitted events wiU not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: .S' �v1 �11��'• �LC� <br /> State License# /�i���J m� �'s-�.�P C 2'�,f� 7 J Expiration Date: �� <br /> Phone: cell office <br /> Mailing Address: 7 " j� T Cit � u r7 ZIP: �' Z 7 <br /> Contact Person: b O Applicant is: ontr tor / Homeowner (Circle One) <br /> Email and/or Fax: r .L C A►� <br /> PROPERTY OWNER INFORMATION: ^ / , � ` <br /> Name: N� �c t�a�ki . <br /> Phone (day): 6 S/ ♦ K � <br /> Address: � , Cit : r✓I � ZIP: �j s yy6 <br /> Email and/or Fax ,G <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��1,�f�r� ��'%f,�i� <br /> Phone(day): �� ' ,. <br /> Address: ���� r � � To r�. L�/ City: ,Lt ✓�K ZIP:,y j� 3Z� <br /> Emaii and/or Fax: _ •� ��� <br /> PROJECTINF � <br /> 1.Type of Project p � � � 3.Structure Type 4.Sewage Disposal 8� <br /> x �. � Water Supply <br /> �New Constructic j Residence <br /> Addition � G�S �' '�f �Garage/Accessory Bidg. �Public Sewer <br /> ❑Accessory Buildi t � Deck <br /> ❑ Relocation Q !,[ � � Office/Commerciai ❑ Private Sewer <br /> ❑ Other: (specify) _ p� � U � ]Warehouse <br /> �- _ ] Storage �Public Water <br /> '"`Any earth movem� (� � ]Other(specify) <br /> MCWD review 8�per /����' ❑ Private Well <br /> Minnehaha Creek Watei /� <br /> 18202 Minnetonka Bivd � <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> vtr.wv niir,���.hahacreek nrc <br /> Estimated Constructi ��4 / � <br />