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/ <br /> , � � � <br /> CITY OF ORONO � ��P ' <br /> BUILDING PERMIT APPLICATION � <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��0�\\ Mai1�P0 Bo�r66. / Permit number. �� �� <br /> i/ � �� Crystal Bay, MN 55323-006 1�� Date received: ����02l�� <br /> � � Street Address:� G��� Received by: <br /> � � ; <br /> �F �/ 2750 Kelley Parkwa �.�� Plan review fee: � � 7�, g� <br /> l�kf� `-'i Orono, MN 55356 O�� _��5-7 <br /> �� <br /> �L— 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 informati n must be sub � ed. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: (� ' �Q, � ' �� /�' � d <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT INFORMATION: <br /> Name: <br /> State License# � Expiration Date: ` d ' <br /> Phone: cell — — office — � � � <br /> Mailing Address: po ��,1,, v Cit � ZIP: <br /> Contact Person: y Applicant is: Contrac r / Homeowner �c���ie one� <br /> Email and/or Fax: Z ;� <br /> PROPERTY OWNER INFORM ION: _ <br /> Name: V �/ � ' <br /> Phone (day): /a— �a —/ SIS� <br /> Address: �v� G� rp.� � Cit : �/'lPJ�1p ZIP: <br /> Email and/or Fax (�aU i ll�f'{�IeIQ @ Qfll•CeWI <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /��� <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> r� <br /> PROJECT INFORMATION: Description of ro�ect: �2.�v � �,�'�/�d�% A�'�� ��hQ,w <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �New Construction �Single Family with �Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Private Sewer <br /> ❑ Public ❑ Storage �Public Water <br /> ""Any earth movement may also require ❑Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ �ndustrial <br /> Minnehaha Creek Watershed District MCWD ❑ PfivBte Well <br /> ( ) ❑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) $ 3!✓�j �`> <br />