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. i <br /> CITY OF ORONO �7� <br /> BUILDING PERMIT APPLICATION '� `'�"� <br /> FOR NEW STRUCTURES OR ADDITIONS � <br /> /�O A, Mailing Address: Permit number: �70 -�OD Z 5 <br /> � �y� PO Box 66 <br /> / Crystal Bay, MN 55323-0066 Date received: �-�-� <br /> 1 � �5 <br /> � I • Received by: <br /> Street Address: �}'/ // <br /> ti \,' 2750 Kelley Parkway Plan review fee: 9� `t�Z � • <br /> `�tq �E.� Orono, MN 55356 ,,�0/�-GaC�OZ <br /> KEst�� 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 must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3Z2 S C�.Sc P c v c�� , ����� <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 will 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: ��<,..T�c �� � <br /> State License# �Q,� 3os Iti Expiration Date: <br /> Phone: (cell) ��Z, 2b'►-��"►o (office) �i (o12-y�2- �o� � <br /> Mailing Address: I S�i £ L-r< S�c._� Cit : � Z-•�h ZIP: S 53�t � <br /> Contact Person: 5��� (-���ss�1 Applicant is: ontract / Homeowner (CircleOne) <br /> Email and/or Fax: Sv� C� �-t'�-a�Z , ��� <br /> PROPERTY OWNER INFORMATION: , <br /> Name: M rYv �.�rn�� ��(',�-�h M Q'(t l'u� � s �4' ', � � <br /> Phone (day): 9� 2e o - q'�10 <br /> Address: City: ZI P: <br /> Email and/or Fax M�,�.� a P� c�M�ti� � t�-'� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: n.��y�._ sti.,«�.-/�� <br /> Phone (day): q�Z_ - N�o- o��so <br /> Address: 646 �'? 9�Crtic-� City: �fc�fy;� ZIP: 7S�3l <br /> Email and/or Fax. t� r -f-'�' <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �Single 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 1 ,, <br /> Phone: 952-471-0590 ���5'r"'� dc�� <br /> Fax: 952-471-0682 C � j' r�N�a <br /> www.minnehahacreek.or n <br /> Estimated Construction Valuation (excluding land) $ � �2C ,,,d oP <br /> —�---�� <br />