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CITY OF ORONO <br /> ,. <br /> BUILDING PERMIT APPLICATION <br /> , FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: : •= <br /> g-��O PO Box 66 �� � <br /> Crystal Bay, MN 55323-0066 Dafe received: _��3 <<n�'''��� <br /> StreetAddress:' ,ZO��.� ��i�d by: �� — <br /> �, G� 2750 Kelley Parkway �L �I n;review fee: � � � � <br /> `� Orono, MN 55356 'C <br /> �q�Fs�{Ot�F` <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=requi�e'd iriformation must be submitted. <br /> incomplete applications;will be returned. (Please prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: V � L �E�1.. dl.� l�� . <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> !f yes,a specia/event permit is requi�d with Police Department and City Council approval 60 days prior to the evenf. Shuttle bus seivice will be <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will nof be allowed. <br /> Name RACTOR/AP;L.�dT�INFj9�tphQTf��—� �� `S �.r- C . <br /> � �d� <br /> State License# Expiration Date: <br /> Phone: cell � � office � � yS� <br /> Mailing Address: C Ci : : ��T w � IP: ^ <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Emaii and/or Fax: il CK <br /> PROPERTY OWNER INFORMATION: I <br /> Name: �Zq yw�� 14- �� �4 D� v 'E . <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: S �R w• t. 1�!,i /��jD � L . <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 L�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 earih movement may also requ�re ❑ Commerciai ❑ 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 /> �� <br /> Estimated Construction Valuation (excluding land) $ G �- d � 0 'V. <br />