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w` . ♦4i . <br /> � <br /> CITY OF ORONO C, �--� <br /> BUILDING PERMIT APPLICATION � � <br /> 1 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mai��PO Bo�r66� Permit number. C� - -. C' <br /> � Crystal Bay, MN 55323-0066 Date received: � C <br /> StreetAddress:. -- --.--.--_..__.___..._--- �G_ <br /> y�, � 2750 Kelley Parkway �2��5��`1 � � " . 3�"' `� <br /> G lan review fee: <br /> � Orono, MN 55356 � _ ____.____. -------- <br /> �kEs���� Total Fee: �`�3 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us E�Qu( } �Q, i� � <br /> This application form must be completed in full and all required information must b submitted. 2('��$-QpgOL <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �U� / � / ,�j� ��- �i��� �Q�'3� <br /> Job Site Address: --! �'' l.xr�j L�t�5 rv� � / ' <br /> WII 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 wil!not be allowed. <br /> CONTRACTOR/AP LI NT INF RMATION: <br /> Name: �� � �QQS • <br /> State License# Od 2 Expiration Date: 31 �-d� �_ <br /> Phone: (cell) (ob1-Z7D " (office -�5-O�.3 <br /> Mailing Address: ( — �. �/e Su tOt City: r�Ae ziP: sT3 3 <br /> Contact Person: � �q " Applicant is: ntractor Homeowner (Circle One) <br /> Email and/or Fax: l,V �c.Q o <br /> PROPERTY OWNER.I�JF�kOI�AT�N:\ � r <br /> Name: N� �C�'4A�. C� ��w� tcleC,S . <br /> Phone (day): - �-' <br /> Address: � �,L, '- -G t2�V�. /�, �D� Cit : ��n� ZIP: �J33� <br /> Email and/or Fax EA e iJ��v 4 t . C <br /> ARCHITECT/ ENGINEE FORMATION: <br /> Name: J <br /> Phone (day): a - � \ I� (/' <br /> Address: — � ',PL Q,t1/:Q .�,C � Cit : Y�'��� ZIP: ��`� <br /> Email and/or Fax: y{n 1/ d ld �� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ew Construction ❑ Single Family with Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �blic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <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& 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 /> vwvw.minnehahacreek.or <br /> � �-1�)�� —1 �`��-� <br /> Estimated Construction Valuation (excluding land) • � �--�; / 7 �j <br />