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� <br /> . � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: o�O -G l <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��� �.S <br /> StreetAddress:' Received by: �� <br /> y � 2750 Kelley Parkway Plan review fee: /� . / <br /> Ftq �,�' Orono, MN 55356 �l S� U��O <br /> kFSH� <br /> � <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 must b ubmittecN' '/ <br /> Incomplete applications will be returned. (P/ease print) �, �`7� . 9`�' <br /> GENERAL INFORMATION: •j��.��� �y�n� �'�23%/5 <br /> Job Site Address: 79�-\O �f��p � '�� <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 Counci/approva160 days prior to the event. Shutt/e bus service wil/be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �S U'Zt� - CZ� �vLTI•►.AN c�r�S c,T�c�r� �LC. <br /> State License# � Expiration Date: b3 3� �'] <br /> Phone: (cell) (,Q�2- '}0� -33U'� (office)NA <br /> MailingAddress: �� vS 2 Cit : 7� ZIP: 53"�`i <br /> Contact Person: `�.�,5 �Lz w•At� Applicant is: on ac o / Homeowner (Circle One) <br /> Email and/or Fax: ti1p, <br /> PROPERTY OWNER INFORMATION: <br /> Name: \���� + t-'��cti�.1� A�`���C <br /> Phone (day): ��-tc3 - �1H2-�-(k51 <br /> Address: 2 CR c� �i O Cit : � ziP:55 <br /> Email and/or Fax - 1n , bb�,t1, m.�; .Cs.�M a.hrr,ott .wu.:,� � \ . <br /> ARCHITECT/ ENGINFF.R INFORMATION• <br /> Name: _ ���'�i- l-�P��/�� .5�. _ <br /> Phone (day): (0�2- '.t3 2 -3�--1qT-�2G� -G+�G.�*'E.c--;�� <br /> Address: 52 -4�. Cit : ,n� t�lpbV ZIP: 55 <br /> Email and/or Fax: �z _ � 4a..E���v .S� .�tjY.•� <br /> PROJECT INFORMATION: Descri tion of ro�ect: �1t:� N 1N'f�.R�J(t-- ��-�^"��- <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&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) $ Z��i �j <br />