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� CITY OF ORONO � <br /> , � `� <br /> BUILDING PERMIT APPLICATION �I g` <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �� ��/� <br /> PO Box 66 <br /> � 0 Crystal Bay, MN 55323-00 6 Date received: , `l — <br /> � � StreetAddress:' 1 Received by: ��, ..3 � <br /> � 2750 Kelle Parkwa � ���-U/D 7"" <br /> ti � y Y G�' Plan review fee: <br /> `� � Orono, MN 55356 (��� <br /> `�KESHO4� 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 ali required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��,�q $ Cas Co C��G� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dispiay Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Councif approva/60 days prior to the event. Shuttle 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: Fa�.- •t- So �a {�ew�odz�inq <br /> State License# 3C b3�q o'1 Expiration Date: D 3 (3 t l�o�� <br /> Phone: (cell) 1�(2- Sy�- 833"1 (office) (012 -2��-58 2 6 <br /> Mailing Address: 2 o E v Cit : Chi 1�� ZIP: 531b <br /> Contact Person: � ,�e.,ss� Carlco*� Applicant is: ontractor / Homeowner (Circle0ne) <br /> Email and/or Fax: ' 2;,r n u r de 1 . co w� <br /> PROPERTY OWNER INFORMATION: <br /> Name: K n-F av, d Su2.y Sw�hSah, <br /> Phone (day): <br /> Address: 3ZZ,q (3 Casco Ci�cL� City: O�ono ZIP: 5534 ( <br /> Email and/or Fax c�ar�s�? � a o I Co w� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> ►vame: I�tark NQ.sse-}- <br /> Phone (day): <br /> Address: (o3Z� �Iw 't'rc,� A�v City: �xc,�,�sior ZIP: SS33 � <br /> Email and/or Fax: I�.�ar k A h�s r�,��p c-�,�r �o� <br /> PROJECT INFORMATION: Description of pro�ect: w, � ���' �� <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. $� Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Retocation \ detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [�Other: (specify) I?-�to V�w�, ❑ Multiple Family!Condo ❑Warehouse <br /> ❑ Public ❑ Storage �$Public Water <br /> *"Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (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) � (o�{ 0007 <br />