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. ' /w'✓ i <br /> if � � <br /> CITY OF ORONO � .� �.�3� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: �/� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: g' <br /> street Address:' ---- � �`� C� <br /> y� � 2750 Kelley Parkw �`C�.�QQ�j�� Plan review fee: � � � <br /> t � Orono, MN 55356 <br /> qkEs H 0�� <br /> Total�ee: �OU✓ <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.�py,���t�/ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��. <br /> Will this be a Parade of Homes, Remodele s Showcase Home or other Display Home? Yes ❑ No <br /> lf yes,a specia/event permit is required with Police Department and City Council 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: <br /> State License# sq N � Expiration Date: �2-3►-i <br /> Phone: (cell) 612- 26'1-ZG"►c (office) �,IZ- H6Z- yc� o <br /> MailingAddress: 1 3 L.,� 5-t � Cit : �..,, Z.,r�-- ZIP: 553at <br /> Contact Person: So� (-�ws�,,t<„� Applicant is: n ract r / Homeown (Circle One) <br /> Email and/or Fax: SwtN @L��-�„�,_,,,��Z , c��.•� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �#.� SJt►� L���a <br /> Phone (day): �Iz- 2��r - 'y6�� ��,��,� <br /> Address: 5 N2e �ruzy ���- City: c� ZIP: 5 5'36K <br /> Email and/or Fax sd2a n 5-��0�1_ c cr--� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I�.,-� /��1,U,...�1 <br /> Phone (daY)� �t52 - �t�3- 4s'7'�'7 <br /> Address: �P 1 ���� g�t f.,ss�( City: �^/�7z�,r,,, ZIP: 5 5 3� � <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: Lc�yCr�c�'�a �� I�o� � -� Iw..��� o�-(-F�,� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> � New Construction �J 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) ❑ 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 /> � <br /> Estimated Construction Valuation (excluding land) �2 5�o c o <br />