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• - - � <br /> , , �, � ,� �� � �1, "75 <br /> o�,� CITY OF ORONO <br /> � <br /> , <br /> , ", - <br /> ' BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: aQ� 3 _� � <br /> PO Box 66 Permit number: <br /> � �� Crystal Bay, MN 55323-0066 Date received: � � R/�0��$ <br /> a � � Streef Address:� Received by: (o G ��� <br /> S.F � 2750 Kelley Parkway Plan review fee: o�3��•8`� � G,��V <br /> CqkESH���� Orono, MN 55356 ���3,� � <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: d <br /> Job Site Address: �i� 5� ��M � �jQ�Lri �(Z�/�b �K S.5.3.5 <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 Ciry Council approva/60 days prior to the event. Shutt/e 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/APPLICANT INFORMATION: <br /> ►vame: S15�- �A G Zbu t� �-1� ��'S qF- t� E /�/IdDE L yn( <br /> State License# C, � Expiration Date: <br /> Phone: cell ' - Z p office 7' (o - -3 <br /> Mailing Address: 2 S LT ST 6C , Cit : E ZI : ,� - �, <br /> Contact Person: G�, Applicant is: ontrac / Homeowner (Circle One) <br /> Emailand/orFax: KhQ,�� Cor„Qr5tbh2 G c i �C. , cc�en� <br /> �ROPERTY OWNER INFORMATION: <br /> Jame: M A t7' �' K��S7�t� E �2�TL <br /> Phone (day): � (o� 2 �- �(�2 - (ob53 <br /> Address: Z = VE Cit : �,L11(CYN S <br /> Email and/or Fax ry,��- �'�-;.}2, 2 l(, (n,o3-n�►al � C oM. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> ►vame: I� �REK P N�'[.I. ��5 S �}FC 1�E �4vEpl 57��Tv�/tL <br /> Phone (day): (v 1 2 -- 2$ 4 - 7p 3 3 <br /> Address: � g Cit : M?LS ZIP: S' <br /> Email and/or Fax: ��..�o � 54 G�.u�CnS @ . CG� <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. �ublic Sewer <br /> ❑Accessory Building ❑ Singte Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ O�ce/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&permits. ❑ Industrial �rivate 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.mi nnehahacreek.or <br />� :stimated Construction Valuation (excluding land) $ �" .��C✓i �1�� <br />