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�e CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> ' FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number. G �� <br /> �-��10 PO Box 66 r��/�4 G/ � <br /> C rystal Ba y, MN 55323-0066 Date received: <br /> �, � Street Address:' Received b : <br /> � � 2750 Kelley Parkway ,� ' Plan review fee: � . �- 6'� � � <br /> ��,� Orono, MN 55356 �D�� jSl�`� <br /> `AKE 5 N� Total Fee: �i�� <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 /> lncomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: `� 5 ��-�^�n( c ,� ��F. � /�l� � rvY►v �N S i,j �' � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> !f yes,a specia/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 sufticient on-site parking is availab/e. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��(/fL �LNf��j'EN5 NV�` <br /> State License# Expiration Date: <br /> Phone: (cell) L7(Z -2$� — ��S (office) <br /> Mailing Address: C� : ZIP: <br /> Contact Person: Applicant is: Contractor / eowne cc��ie o�e> <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �/9UL_ �N���NSf�UE <br /> Phone(day): � (,� 1 � - ����-�j�f5``�' <br /> Address: n 5 �c�✓✓i d� ( , l�� �lJ Q�c�+c; CitY: �y�,rv�o ZIP: ��� � � <br /> Email and/or Fax ��iU�?�cNR-��NSIiU� �s,i+c�i�7��i.. �oFvi <br /> n „�.�-.-.�.�� <br /> ARCHITECT/ENGtNEER 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& <br /> Water Supply <br /> ❑New Construction ❑Single Family with ❑ Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. 0 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 Disfict(MCWD) �Other: (SpeCi <br /> 18202 Minnetonka Blvd �,� � �, <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fau: 952�71-0682 <br /> Estimated Construction Valuation (excluding land) s �5. So� <br />