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. . �,. � � <br /> CITY OF ORONO �y-� vf' <br /> f� � �7�.� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS �F�v�-�' �r� <br /> �O�O Mailing Address: Permit number: �j r(�d � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 �v Date received: � � �� <br /> Street Address:� �} j 3(F' Received by: �S �L1 G <br /> y�, � 2750 Kelley Parkway(� Plan review fee: � ��Z �� <br /> lqKESHO�c�,�' Orono, MN 55356 <br /> Total Fee: ��I 3-D�6 �� <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: �.�Ej}��Ae,v��,��-��.�� ��i�p, �A,�• <br /> Will this be a Parade of�`lomes, Remodelers Showca e Home or other Display ome? ❑ 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/APPLICANT INFORMATION: � <br /> Name: �L���,�T�1,-.p f.X�,�{'a <br /> State License# Expiration Date: <br /> Phone: (c�����,—����j (office) <br /> Mailing Address: Cit : ZIP: S <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: C,U�y�� ti..}�,w�j <br /> Phone (day): <br /> Address: � ,e„�,.v�� ��,�,�,.aF City: ��p�Q ZIP: S�j35(o <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: }� 1� <br /> Phone (day): �� <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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&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 /> $ �/ .I <br /> Estimated Construction Valuation (excluding land) �.,v>>(��D <br />