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CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number. �� ��d <br /> PO Box 66 <br /> � 0 Crystal Bay, MN 55323-0066 Date received: —Zg — <br /> 4, � StreetAddress:' Received by: <br /> �,'F `f+ 2750 Ke�ley Parkway Plan reviewfee: .J'` <br /> \t,q ��' � Orono, MN 55356 <br /> , xES4,o� oZoi y- <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 fuli and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��1�� ✓�r'�C/�Z' �� , ��,���/4 .��3s'� �. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a special event permif is required with Police Departmenf and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cienf on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR!APPLI NT IN OR�►IIAT�.pN: <br /> Name: ,� �'� ,� <br /> State License# - Expiration Date: <br /> Phone: cell office / - 7 8- 7 <br /> Mailing Address: j�/ L Ci : pp ,C ZIP: 5'-,S'/a 5' <br /> Contact Person: �� ���/,g �/�A���L Applicant is: Contractor / h`(omeowne� (Circle One) <br /> Email and/or Fax: ,�/��s/,��sli�d� ���� l'��, <br /> PROPERTY OWNER INFORMATI N: <br /> Name: _���ih/ .5,9�"�l�G��cG� <br /> Phone(day): <br /> Address: 2/3f c/�L/�/ ,� City: �.�jfi1/� ZIP: ,S,3.5�,� <br /> Email and/or Fax ,.����� �7� NQ 2���„� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /' � <br /> Phone(day): ,� i� �r'p <br /> Address ,;i` ✓'�� ���: ;' �`�'� ZIP: <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 /> ❑��dition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> �Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ Multiple Family/Condo ❑�arehouse <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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) <br /> $ �����_ t� <br />