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• <br /> � CITY OF ORONO (� -, J�--� <br /> BUILDING PERMIT APPLICATION � �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �'�O Mailing Address: Permit number: �/3" � � <br /> � �O PO Box 66 I� <br /> Crystal Bay, MN 55323-0066 Date received: � —rV <br /> StreetAddress:' Received by: <br /> y� � 2750 Keliey Parkway Plan review fee: � `a� - <br /> � Orono, MN 55356 7� ' / <br /> `9kfSH0�� �`�/��j "Z���7"�� <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 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �2 l S' 1�a-� ���..� ��uc� � �},��,�„�� �U' <br /> WII this be a Parade of Homes, Remodeters Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a specral 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 su�cient on-site parking is available. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICAN�INFORMATION: <br /> Name: Sol� ,.,,.,n-�a,-;�,.� C_�� �� �,..c-r'. � <br /> State License# Q c �,��,(� � l Expiration Date: ��/31 /r <br /> Phone: (cell) (,��- ��- 31Q� (office) ��v�ce.. <br /> Mailing Address: �-{3av �: 5 , � Cit : (,qi�nnb; I�t-T� ZIP: S�-ta I <br /> Contact Person: d'�h,� p;.,,n,� Applicant is: ontracfor"�/ Homeowner (ClrcleOne) <br /> Email and/or Fax: � o v�v� �d v�n,� � v�e , c�w� <br /> PROPERTY OWNER INFORMATION: <br /> Name: 'r��nn O.;���`� <br /> Phone(daY)� C�l�- �'.f8v -Cc999 �/��� �;a <br /> Address: �J10 r3t�oa�5 (��n City: r� ZIP: 5339� <br /> Email and/or Fax -r:.,,�� ��.j �;, „��,;r , ��,�,,,� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (3�;uv� 1-}�r�v� <br /> Phone(day): "�i�3- ����l - a�`� �- <br /> Address: �. �r ti3c� 3 �S' City: Q�lu� � ZIP: ��3� <br /> Email and/or Fax. 4��p5 � cx�1 v,,,,��n �;- c;e ��a w� P� : ��w� <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 �,peck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> �Other: (specify) ��C.✓� ❑ 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) $ � , ��� , ��� <br />