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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,, ���� Mailing Address: ; Permit number. �Q/3 -+D/2� <br /> �` Crysal Bay, MN 55323-0066 ? Date received: �2 �3 '_��_ , <br /> ��� , .______ _ _ __._. ____, <br /> �, ' ^ Streef Address:' rz��� + Received by: � S_ <br /> �: � � 2750 Kelley Parkway y � �i; Plan review fee: <br /> �t �,t`�%" Orono, MN 55356 � � � <br /> `?�_r�u�.- �� ; Total Fee: � � 70� . � ' <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 _ <br /> Job Site Address: _ �`�t�� f-�;:�C c /-! f'`��_;� ._L��.' �'�-� ✓�- G�'�� <br /> Will this be a Parade of Homes, Remodele�howcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special event perrrnt is required�vith Police Department and City Council approva160 days pnor to the event Shuttle bus service will be <br /> required unless appl�cant demonstrates suificient on-sfte parking is available Non-permltfed events will not be aflowed. <br /> CONTRACTORlA PUCANTINF RMA ON: � <br /> 1_ 1 ,, •r �(��' ��-� _N ;' 't 2 <br /> Name: ��r r r �S- � - <br /> State License# �,-�<:� • % � Expiration Da e: �- - �1 j <br /> Phone: cell - � - � office ��� - / `-� �' -- l � <br /> Mailing Address: , ;�,� �a Cit : � r ZIP: �-; <br /> Contact Person: �- .� , �_, Applican � ontractor )/ Wdmeowner (Circle One) <br /> � . � �_.__ _ <br /> Email and/or Fax: '� � �+ -,�� " �r.,�-t `�'-j��� � /Y? . CYr�'Lt� <br /> PROPERTY OWNER INFORMATIO : <br /> Name: ��If�' ;'�• /�/� rit� <br /> Phone (day): � �-� - �? `Z - � � <br /> Address: jl;.3� - U'. L� /'� Cit : �,r�rr D ZIP: 3�'/ <br /> Email and/or Fax /;,� /r��' � � �. - � �1 <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br />��_`. !�;.,'�,,� ;,-�. ��� "�% �-:';'1 i t ,'�t� " �" ��1-7(�'r-;=r'�oc �� ` :.rL /c�1E��J � �i t`'�uJ /G'L�`,�-���-l�� <br /> PROJECT INFORIIIfIAr710N. Description of project:/ , � ��- � � � � ,.� -> � <br /> � 1. Type of Project ' 2.Proposed Use � 3.S ructure pe 4.Sewage sposal 8 � <br /> Water Supply ' <br /> ❑ New Construction ��Single Family with ��Residence � 1 <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 i � <br /> I ❑ Public ' ❑ Storage � ❑ Public Water <br /> "Any earth movement may also require ❑Commercial � ❑Other(specify) � � <br /> MCWD review 8 permits. ! ❑ Industrial ' ❑ Private Well ' <br /> tilinnehaha C�eek Watershed IJislrld(MCWU) �Oth@f: (Sp@Clfy) <br /> 18202 Mmnetonka Blvd i <br /> Deephaven,MN 55391 ;�'��i/�G'?i(�2/ f <br /> Phone 952-471-0590 i � <br /> Fax 952-471-0682 I E <br /> www minnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ �� ��. � <br />