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-------- <br /> i— --- <br /> CITY OF ORONO � <br /> BUILDING PERMIT APPLICATXAN l��•� <br /> � - <br /> FOR NEW STRUCTURES OR ADDITIONS - <br /> �O . `O Mailing Address: � Permit number: �Q - / � <br /> 1V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'�d-/ <br /> Street Address:' I�� Received by: <br /> y� � 2750 Keltey Parkway � I��� Plan review fee: /�Jr . <br /> L Orono, MN 55356 � <br /> `�'�ESH��� Total Fee: °2D�y-Ol//S <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: �� � f�� S � <br /> Job Site Address: G <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes .� No <br /> !f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> rer,urred unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br />► CONTRACTOR/APP CANT INFORMATION: <br /> Name: �p <br /> State License# Expiration Date: <br /> Phone: cell 1 office <br /> Mailing Address: ti.J ;� <br /> Contact Person: Applicar <br /> Email and/or Fax: ' a ' / <br /> �� ��� �'� � I� �� <br /> PROPERTY OWNER INFORMATION: ��� <br /> Name: i <br /> ��� -�.lil7r✓t d7.J �' — <br /> Phone (day): �� � <br /> Address: �G�,� �D ���C'1'� �� � ��7�'� l����� � �. - �_-��<��`1 _ <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): Z�3�-`� e,��,"� �"Q� <br /> Address: <br /> Email and/or Fax: wQ,�� � �j �j(��J�_ <br /> � <br /> PROJECT INFORMATION: Description of project: <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. ❑ 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 /> $ �, <br /> Estimated Construction Valuation (excluding land) 1��jQ(� <br /> �• <br />