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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION ���• �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, MailingAddress: Permit number: �(�� -b//�� <br /> � <YO PO Box 66 '- <br /> Crystal Bay, MN 55323-0066 Date received: 9- /s-/ <br /> � � Street Address:' _ Rsceived by: /�j�� P <br /> tiF G� 2750 Kelley Parkway n��,� Plan review fee: �- , '�'!C� �� <br /> lqkfSHO�� Orono, MN 55356 �� C:� O/� D/�7� <br /> Tota ee:- - -- .; "� <br /> Main: 952-249-4600 Fax: 952-249-4616 v�n-vw.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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ?�y;�j� �' ���y �-�f <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> /f yes, a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site paiicing is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '���r�� G �lrii(:., I �s �� , � <br /> State License# �k-,�,�'c��� �:4>-�� Expiration Date: � 3i Z�, <br /> Phone: (cell) c�I y. ' �{aU i Z�C; (office) --��w,� <br /> Mailing Address: y��.4 �.� s.r � ,ei City: �,cc;c_��� �? ZIP: 55.=>>I <br /> Contact Person: ���-; Applicant is: n-fr� / Homeowner �c��ie ooe� <br /> Email and/or Fax: p,,�,�r�,�,;t,,., �.; (�� Cm�u� - C��lr <br /> � <br /> PROPERTY OWNER INFORMATION: �Q��TC rC q'�G �io n�►£i� Hqs�v. Co.+� <br /> Name: -�ratlti�rv�i��t i,�L.oTT �i��v��:,�. <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ���:�,�� _►`�'- �►Ls:� <br /> Phone (day): j����� Lk"1 c c�'1 s t� <br /> Address: ��q Zr-�� sT � ��� City:��c�.:.i�� �� ZIP: S�>>>� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro�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 QGarage/Accessory Bldg. �Public Sewer <br /> Q Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ OfficelCommercial ❑ 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 5539t .� <br /> Phone: 952-471-0590 ���'�_ <br /> Fax: 952-471-0682 ����,���.� <br /> www.minnehahacreek.or >� �I�Da <br /> Estimated Construction Valuation excludin land � �i�' ''���4` <br /> � 9 ) / , � c����-�� <br /> � <br /> CIN QF ORONQ ' <br /> V ..�......� _ . J <br />