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�- . � 3' <br /> CITY OF ORONO � /' / /- a� <br /> ��---_— ---- ._ <br /> BUILDING PERMIT APPLICATION �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: C � <br /> �' Permit number: � �3 N�� z <br /> , �ONO\ PO Box 66 , / <br /> ` Crystal Bay, MN 55323-0066 Date received: �-f' `l0�- 1 � <br /> � 1 ' Street Address:� ,�' �'� <br /> ` '' � 2750 Kelle Park J ` 3 � � � � 3C3 j <br /> \'��� : i'� Y Y ����nl'� �I Pfan review fee: •'�K- C��"7i� <br /> \ � `-' ` Orono, MN 55356 <br /> ��fSHO��i� <br /> _ Total Fee: <br /> � Main: 952-249-4600 Fax: 952-249-4616 �✓ww ci orono�7�n us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please pnnt) `�'-,��' �-�� �9b 7 ��Z� <br /> GENERAL INFORMATION: �p <br /> Job Site Address: � S �!J��v �d��k—� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ANT INFO TION: <br /> Name: �'f Z l�l/���j� N� <br /> State License# ° � - Expiration Date: - a/ <br /> Phone: cell % - - 'Z (o office �� ,�- <br /> Mailing Address: .�2u� Ci : /�p ZIP: 3S <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: - l¢ <br /> PROPERTY OWNER ORMATION: <br /> Name: � /U <br /> Phone (day): �ti /'� <br /> Address: Ci :C//Z, /1�C� ZIP: � � <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �� <br /> Phone(day): '"�(v 3- ' - �7,(.1 .Q� /� <br /> Address: O ,M 14S 1/� /VU Ci : i LN �C�"�1P: � <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& <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 ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> `"Any earth movement may also require ❑Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wvwv.minnehahacreek.or <br /> f.�} <br /> Estimated Construction Valuation (excluding land) $ �j � , �. <br /> -� <br />