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� <br /> . . � �b � <br /> CITY OF ORONO � �03 <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: ��`�—� <br /> O PO Box 66 L <br /> Crystal Bay, MN 55323-0066 Date received: ,J ' �� ' � <br /> StreetAddress:' Received by: <br /> y�, � 2750 Kelley Parkway Plan review fee: �0� —�� I <br /> lqkf ��� Orono, MN 55356 /O �� �.q <br /> s H° Total Fee: � '� <br /> Main: 952-249-4600 Fax: 952-249-4616 �vw ci cron�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: / / _ / �t <br /> Job Site Address: Z, � z q C G!J�qp7t �y L D/ 7 ��Y/► li '� � % <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. Shutt/e bus service �ll 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: S %ot2 � � c.e, L�l.��'/C��✓s" � C <br /> State License# 1(!�/ , �' C�� Expiration Date: / <br /> Phone: (cell) /Z �6,Q �',�US� (office) <br /> Mailing Address: / y f.f' 7� b� �^ c�c-i<l'on L�il City: /� ct ��T�� Z�P� S S"� Z 7 <br /> Contact Person: 7`c� � C�S'��z r Applicant is: ontract r / Homeowner (Circle One) <br /> Email and/or Fax: �'�rrr C�S"f'o�r �,�+�►���`� I�c��^ <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�TfJM� bt�v,��....I�.�.1rf LLL <br /> Phone (day): (r 2,,��, ' <br /> Address: / y S � ��C /�% City:�Jj���G� ZIP: ,�j�j �yG <br /> Email and/or Fax y'�,�,,,, Q s.<'e✓ � a� �.•L, Cn a. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 7`D�•; f]S/=� " <br /> Phone (day): 6 ' � $ <br /> Address: � �,a �. �9 Cit����� ZIP: 5.5�.�� 7 <br /> Email and/or Fax: 7'" � <br /> l% 03� 9 <br /> rROJECTINFORMAI � � D <br /> 1.Type of Project / �J `� . ire Type 4.Sewage Disposal& <br /> � Water Supply <br /> �New Construction � � ice <br /> ❑Addition �,/ �, _ . ) /Accessory Bldg. �]Public Sewer <br /> ❑Accessory Building /�' ��j�,�Jl ;(�(/ <br /> ❑ Relocation v �//�yt.i 'j`'� �mmercial ❑ Private Sewer <br /> ❑ Other: (specify) �' �e <br /> �Pubiic Water <br /> ""Any earth movement may als cify) <br /> MCWD review 8�permits. ❑ Private Well <br /> Minnehaha Creek Watershed District� <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> tiv�vw.minnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ / �� � <br /> , <br />