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1 <br /> , <br /> � CITY OF ORONO <br /> � <br /> BUILDING PERMIT APPLICATION <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> / � Mailing Address: ,�;/c./--�:G h���(F, <br /> 1 �D�I� PO Box 66 Permit number: ' I <br /> %� Crystal Bay, MN 55323-0066 Date received: <br /> � �� StreetAddress:' Received b : <br /> `�`� � ��f' 2750 Kelley Parkway �� � J Plan review fee: � .. '� !.<-' �i� 5�1 f� <br /> F� Orono, MN 55356 �G gf ,l <br /> 'k�sHo�� �'g`" � q <br /> ___ Total Fee: �� �1 <br /> Main: 952-249-4600 Fax: 952-249-4616 <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: � � �L� �^c���� ` ;� �� .: � /v� � ✓c'Y�c� '�'�J % % j � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days pnor 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��y� �L/l/fl/'��^�SN��' <br /> State License# Expiration Date: <br /> Phone: (ce11) (� �Z - 2`�� — y 1 S (office) <br /> Mailing Address: Ci : ZIP: <br /> Contact Person: Applicant is: Contractor / eowne �c�«ie o�e� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �/-i�?l� 1�' �A��/Il5 d+11 E <br /> Phone(day): j; � � - ��J -�� <br /> Address: �].� ��✓ri d h� � (Z� /�J. . �«na CitY� �� d✓�o ZIP: �j 3 �� <br /> Email and/or Fax f�,�1 i>L<�j�/���4 r3��15 ft UE- E_ �v�t��r4�3� , �or°vr <br /> n �,�,.>.-.�...� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description 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) ❑ 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: (speCi <br /> 18202 Minnetonka Blvd �;���� Q, <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fau: 952-471-0682 <br /> Estimated Construction Valuation (excluding land) $ �15 ��� <br />