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� CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> p' Mailing Address: Permit number: � U�I(c l <br /> ���y� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� <br /> ��- � StreetAddress:' Received by: �Z � <br /> s 'I� �� 2750 Kelley Parkway Plan reviewfee: �� <br /> � Orono, MN 55356 <br /> `�k�'�x v�� Total Fee: � L) • �� <br /> Main: 952-249-4600 Fax: 952-249-4616 �nnNw.ci.orono.mn.us y <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��ddress: ��(Ci G Cr�L s�=�_ ('-t fzta ���L�-�z�.�{1; ��r�% 553`�/ <br /> WII 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 approva/60 days prior to the evenf. 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 I APP�ICANT INFORMATION: <br /> Name: {� I>C s,� ,�-� r-`_� <br /> State License# - j `�i�( Expiration Date: �, -31-)�„� <br /> Phone: (cell) (office) <br /> Mailing Adcress: ?z�, Iv rY-tirJ �''-1 13 City:(��,-�,7L�,lle ZIP: 55��3� <br /> Contact Person: {�;,,� I,.. a� � Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/ar Fax: �5`a-- � `�`l�I —��'� U C <br /> PROPERTf OWNER INFORMATION: <br /> Name: �c.,�..1 {{�.�_t-�-.z,r- <br /> Phone (day): � -�� I t.r -`1 c;�'� <br /> Address: �i;li1 �c<<,� v ('t IZc,� City: "vJ�"t--j Z�itz-, ZIP: S ?,,�� 1 <br /> Email and/c�r Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 ingle Family with esidence <br /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ f�location detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �YOther: (specify) �� �4C�✓✓`�-nt ❑ Multiple Family/Condo ❑Warehouse <br /> , n� �� :.✓'� ❑ 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) $ �,- U� �J � <br />