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t T, <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Pe�mit number. �b � <br /> PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: ZI �,j <«MP��� <br /> ` �� -� �eived by: �� - <br /> Street Address:' .�� �,���)V�•_ � � <br /> y� ` 2750 Kelley Parkway � �, ,�� �L ��n�review fee: � � ' � �� <br /> ��:� Orono, MN 55356 �� _ -- _a <br /> __��,— - --- <br /> ����sHp Total Fee: `�"7� D 5� ' I <br /> Main: 952-249-4600 - Fax: 952-249-4616 www.ci.orono.mn.us �-m rec,�0� <br /> This'application form must be completed in full and all requi�etl information must be su itted. '/ <br /> Incomplete applications will be returned. (Please prinf) �'"rv`�� `�����o <br /> GENERAL INFORMATION: <br /> Job Site Address: V � L ���L Ill.� t�� . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> !f yes,a specia!event pe�mit is required with Po/ice Department and City Council approva/60 days prior to the event. Shutt/e bus seivice wi//be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFr6�Z�T1�0��—�� � . <br /> Name: V.,�7 � � S ��-- � • <br /> State License# Expiration Date: <br /> Phone: cell – � office � ' ys" <br /> Mailing Address: C Ci : : ��T w �A IP: " <br /> Contact Person: j– Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: il �Vi <br /> PROPERTY OWNER INFORMATION: I <br /> Name: ;�1e� wN G 14�5 14 D� v 'E <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: S �1 w• � L4�� /��)D � G. . <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 Disposai& <br /> �� Water Supply <br /> New Construction Single Family with L7 Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. Pubiic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Pubiic ❑ Storage ❑ Public Water <br /> **Any earih movemenf�nay aiso �aqu�rz ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial . ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Bivd � <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) $ (j � d � d d. <br /> 1 <br /> ► <br /> ► <br /> � <br />