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<br /> CITY OF ORONO
<br /> BUILDING PERMIT APPLICATION
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> ��� MailingAddress: Permit number: ��� �ll�
<br /> O PO Box 66
<br /> Crystal Bay, MN 55323-0066 Date received: 9' a �/
<br /> StreetAddress:' Received by:
<br /> y�, � 2750 Kelley Parkway Plan review fee: � ,
<br /> t,ykES�o��,L Orono, MN 55356 �� �g �
<br /> oa . 4 /�/'O
<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. . ,,,,,,�ies
<br /> Incomplete applications will be returned. (Please print) ,rc �,P�-
<br /> GENERAL INFORMATIO • -
<br /> Job Site Address: �, 14 1 '-( t„��;�,�y-�i,, �`�,;,,�
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Horne? ❑ 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 su�cient on-site parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: ���....� �e�wsc.-, �4-,-�k-5. ..L+�,�..
<br /> State License# �, L,,� Q,.?�„C3 Expiration Date:
<br /> Phone: (cell) �(�3 -�¢�� -"(3c; � (office) '�'��?,- (�7 q �- 4�..;t�-�
<br /> Mailing Address: l+�cc., C,�.0 �;Z.�. I q C�+r�.�+'YL,���„�a,,. ZIP: ���3�'� -1
<br /> Contact Person: �N�,.,,` Applicant is: �. ractoi' / Homeowner (Circle One)
<br /> Email and/orFax: ,�, ,,�cY, C_ -•,,,,�.�-.�,tic�., ��e�� . Cs..�� -fC:�-� --4-T�^ �`'uL�
<br /> PROPERTY OWNER INFORMA�ION:
<br /> Name: �uc,,,,,�. � �.�c�.c.,�; l v�.�S
<br /> Phone (day):
<br /> Address: City: ZIP:
<br /> Email and/or Fax
<br /> ARCHITECT/ ENGINEER INFORMATION:
<br /> Name:
<br /> Phone (day):
<br /> Address: City: ZIP:
<br /> Email and/or Fax:
<br /> PROJECT INFORMATION: Description of pro�ect:
<br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
<br /> Water Supply
<br /> ��ew Construction �ingle Family with �esidence
<br /> Addition attached garage Garage/Accessory Bldg. �ublic 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) ❑ 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) $ ��j.�� U c,�
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<br /> II � I
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