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`--�----. •► <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �i� _ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> Street Address:' <br /> y� �'' 2750 Kelley Parkway �����"f�;� ��an reviewfee: . ,3�' - � <br /> � Orono, MN 55356 <br /> `�XESH��� 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. (P/ease print) <br /> GENERAL INFORMATION: ���� �a a j���� �� /� � ��� <br /> Job Site Address: �.v <br /> Will 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 evenfs will not be allowed. <br /> CONTRACTOR/AP LI NT INF RMATION: <br /> Name: �� � QS . <br /> State License# �0 Expiration Date: 31 �d/ <br /> Phone: (cell �p�-y?Q �- (office �( -O�1.3 <br /> Mailing Address: — �/ S� fdl Cit : Y�Ae ZIP: S�3 3 <br /> Contact Person: q Applicant is: ntractor Homeowner (Circle One) <br /> Email and/or Fax: ( <br /> PROPERTY OWNER_I�1Ft�OF�NjAT�N:� � r <br /> Name: VN �'a,0�. G. w� �c�eCS , <br /> Phone (day): - ��- <br /> Address: � u, � -E i2�V� /.� 0� Cit : �� ZIP: �J�3� <br /> Email and/or Fax Ep e (,J�dv q { , � <br /> ARCHITECT/ ENGINEE FORMATION: <br /> Name: <br /> Phone (day): a . . \ _� -�^�t/' <br /> Address: — ',PaC. K,ti/� � � Cit : Y�+�}tr► ZIP: SJJ`� <br /> Email and/or Fax: y� {/ d ld �� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ew Construction ❑ Single Family with Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation etached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) [7�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) ❑ Oth2r: (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) � 3 ,����• <br />