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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> �O�TO Mailing Address: Permit number: �- <br /> �V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> Street Address:' �`� C� <br /> % � 2750 Kelley Parkw ���...�d�j�g Plan review fee: � � � <br /> `�t L Orono, MN 55356 <br /> qkFSHOQ`�' 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2 ��. <br /> Will this be a Parade of Homes, Remodele s Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will 6e <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# 5q c( � Expiration Date: i2-3►-� <br /> Phone: (cell) 612- 26'I-2C►c (office) 61y- �16Z- y�� o <br /> Mailing Address: 153 L,� 5-t � Cit : �,,.�. Z.,t� ZIP: 553q <br /> Contact Person: SJ� (-�ws��h,� Applicant is: n ract r / Homeown (CircleOne) <br /> Email and/or Fax: SwZN p� �-f-�,,.,��Z . c�a,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: '�#.� S,rt►� L���'S�,a <br /> Phone(day): 612- 2�� - v6�o �Q,��,L <br /> Address: 5 N2o �ruzy ��L City: c� ZIP: 5 5'3�� <br /> Email and/or Fax sd2� n S-{���o-l_ ��� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: K�-c�--r /�1.��� <br /> Phone(day): �S 2 - ��g- �-t�� <br /> Address: y4,� �..��� c,�t �.,s3'� City: W,-7�z�,.r,,� ZIP: 5 5 3� � <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: Cc�yCc�cj'•�a c� 4to�- � -� l�..a�� $o f�,�S,.� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> / � <br /> Estimated Construction Valuation (excluding land) �Z 5 ,o c c <br />