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� . <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �D/.�� �// <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: l O— �- 9 -/3 <br /> Street Address:' Received by: �� � <br /> y� G�` 2750 Kelley Parkway Plan review fee: �l ���� �� <br /> lqK�SHo��, Orono, MN 55356 a�«_O//�.�-� <br /> Total Fee: <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 us ubmitted. <br /> Incomplete applications will be returned. (P/ease pri t) <br /> GENERAL INFORMATION: <br /> Job Site Address: � ��C�D (�%�iU'�l�I. � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe Display ome?j ❑ Y s ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 da prior to th veny.�Shuttle bu service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. N n-permitted even will not be a ed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � lSE'r� C�� . •�, <br /> State License# •� 7 E piration Date: <br /> Phone: cell .� � office <br /> Mailing Address: i,✓ Cit : � l ;v! ZIP: '"$-3 � <br /> Contact Person: y . Applica t is: 'ractor / Homeowner (Circle One) <br /> Email and/or Fax: � ` s7 � r . �'J� <br /> PROPERTY OWNER INFORMATIO : ' <br /> Name: � �^ <br /> Phone(daY)� 2I lP �/\J Gt�'- .�� �Q:�� <br /> Address: Cit : � �;/"- ZIP: j" ' <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: � � <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> '�lew Construction �ingle Family with �Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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) $ � �D �° <br /> �Q I � <br />