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�� • <br /> � <br /> . .' <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • O Mailing Address: �� ,3 �d� a q <br /> �l PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: / <br /> StreetAddress:' Received by: <br /> y� G� 2750 Kelley Parkway Plan review fee: �� + � , <br /> Orono, MN 55356 �O/3 DO a� <br /> l�KFSH��� 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 /> Incompiete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � ' <br /> Job Site Address: � j �U l�a'��� >�r�- ��'� �_ <br /> Wiii 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 Police Department and City Council approval 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: f�7� I,��5 ��-�a� ��e s .� ��. <br /> State License# �� Z u "L l,`'� b � (� Expiration Date: � �j l� <br /> Phone: (cell) ���3 ����t N�' ��`1 (office) i�>j �`� I ����'�`� <br /> Mailing Address: � ti�.� � 7 =� -�.r� ;t,•` Cit : � d�'� ZIP: ; s �(: `� <br /> Contact Person: /1�1N, t,�� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: �ti��;�.�� �,•,,��,� +:ii•� �� .; 3��� - � � 3� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��<< l i�55��5 -�-� <br /> Phone (day): �� ' ����- zc>vo <br /> Address: 5 S� �_5-f� .,� �1/ City: `;f �l�:.l ZIP: ��6 3�� 3 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> � <br /> Name: 1?l�;�l�n� D�_;;���^`� <br /> Phone (day): �o�7 3`t �, `�� 7� - <br /> Address: Z�P: 5 `' � ��� <br /> `1 l-�.y wc�ct 5���� City: ���5��: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 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 /> Estimated Construction Valuation (excluding land) $ �L `' �: `� �'' �� C <br />