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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: � — � <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —f — <br /> Street Address:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: �1 <br /> `� � Orono, MN 55356 {� �/ <br /> �� ���/ `t"�7' <br /> qkESNv Total Fee: `�"f (� <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: �� FEQ�c/i��E G-,QEE�✓ l�Ai�2a,f-Q., /1��c1. SS39/ <br /> WII this be a Parade of Homes, Remodelers Showcase Home o other Display Home? Yes No <br /> If yes,a special event permit is required with Police Department and City 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 /> Name: QrRA,� �f},Q /¢wy�E6 .�•ve• <br /> State License# 8 C 3 S 7�S�o Expiration Date: 3 —3/— �'7 <br /> Phone: _(cell) ��,� - y qo � y�/d S/ (office) <br /> Mailing Address: 7 y(iO p q�.l A✓ .� . Ci : pT C,�d ,�/ ZIP: „S,s Q <br /> Contact Person: FkAMk /nORR�S6TTb Applicant is: ontrac o / Homeowner (CircleOne) <br /> Email and/or Fax: ¢QAnq�AR hoi»�5 � l�07`��/ Com. <br /> PROPERTY OWNER INFORMATION: <br /> Name: �vshcc� s �,co�E Zl�lv�� <br /> Phone(day): <br /> Address: S/,s F��¢n�ic/F G-,�E,�J City: (,J(}V2o�,�L�v /jJ,vZIP: 5,�39/ <br /> Email and/or Fax ,T��/, ,T' D�gvi D � G-/YI�4r/ � Go�»• <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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) R�P��QF d� ��d ❑ Multiple Family!Condo ❑Warehouse <br /> 4 2A����5. ❑ 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) ❑Othe�: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek or <br /> r� 00 <br /> Estimated Construction Valuation (excluding land) I-t r Ob� <br />