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C�'W-�3 <br /> � CITY OF ORONO q �a <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: 3 �a°9�3 <br /> � �O PO Box 66 /� <br /> Crystal Bay, MN 55323-0066 Date received: 7' ��G^"�� <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� G Orono, MN 55356 <br /> tqkFSHO�� � ?�� •�� <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 required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: b <br /> Job Site Address: j(�a„� �) � �� <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. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP NT NFORM ION: <br /> Name: � <br /> State License# � C � Ex iration Date: / <br /> Phone: cell office � 7� <br /> Mailing Address: ! ` Cit � ZIP: — <br /> Contact Person: � � Applicant is: Contrac / Homeowner (Circle One) <br /> Email and/or Fax: �i <br /> PROPERTY OWNER ly T,�ON: <br /> Name: � ,�� � �')/'�-�� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax � <br /> I <br /> ARCHITECT/ENGINEER INFORMATION: � <br /> Name: <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> L�)s��,� ��i'�.6M I'�-�v�-b� ��'o�-.3 S <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 /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> �Relocation �lN%� ��� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify)�a����� ❑ Multiple Family/Condo ❑Warehouse <br /> �9-5 ��� C�12�,uA.J�/a�yuy ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may als require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Oth2r: (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) $ ��%, �pa -� <br />