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. ' - CirY oF ORONo BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS O Mailing Addiess: Permit number. ls�� g- NO PO Box 66 — Crystal Bay, MN 55323-0066 Date received �"�� StreetAddress:' Received by: y �' 2750 Keliey Parkway Plan review e: �l,�k�SHo4�,L Orono, MN 55356 � �I� � `�� Total Fee: � �� Main: 952-249-4600 Fax: 952-249-4616 ��w ci.orono.mn.us ! This application form must be completed in full and all requireti information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 32 z S �.s�o G�r�/c r owo Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a specia�event permit is requirod with Police Depertment and City Counci!approval 60 days prior to the event. Shuttle bus service wiH 6e required unless epplicant demonstrates sufficlent on-slte perking is availeble. Non permitted events wiB not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: 5�a�a w co� � 4.i..G State License# aG 3v59 Z Expiration Date: Phone: cell 9S Z -2s0- o office G!2 -�l bZ '�JOOo Mailing Address: 3 « Cit : W a c. ZIP: S'�39 Contact Person: ("1�o a.c $' Applicant is: on rac o / Homeowner (Circle One) Email and/or Fax: n�►� a uraoo . Cow. PROPERTY OWNER INFOR TION: / Name: /�av i�• �,.�n.� �r.j� Ls.Gs�M,A Phone (day): SrS2 -ZG� - 9'8 70 32Z5 ��-s� � ''L� Address: C�ry�_��Y�� Z�� 5.53�� Email and/or Fax M 'ee MQ tZZ $ �' �K� i L . Cm� ARCHITECT/ENGiNEER INFORMATION• Name: /'k�{cc �v r a�' Phone (day): g S Z" 70 - q�SO Address: � S rcr. Ci : 1�1tc��SiOv ZIP: SS 33� Email and/or Fax: /"l� � �' r r a sr`t u . c0� PROJECT INFORMATION: Descri tion of ro'ect: 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 Water Supply � ew Construction �Single Family with Residence ]NAddition attached garage Garage/Accessory Bldg. $�Public Sewer ❑Accessory Building �Single Family with ❑ Deck ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer ❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse ❑Public ❑Storage �Public Water "'Any earth movemen!may also require ❑Commercial ❑Other(specify) MCWD review 8 permits. ❑ Industrial ❑Private Well Minnehaha Creek Watershed Distrlcx(MCWD) ❑Other. (specify) 18202 Minnetonka Blvd Deephaven,MN 55391 �� Phone: 952-471-0590 Fax: 952-471-0682 ��. �p /IG+Ka,K www.minn hahacreek. r Estimated Construction Valuation (excluding land) � 1, 2'2�i D�O -- ' f ; ;