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< � <br /> �. <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �OA, Mailing Address: CJ ""O U � <br /> r VO PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: 2 1 �j � -r`-, <br /> 'ved b : � �' <br /> a Street Address:' -.. --_ <br /> �'�. � 2750 Kelley Parkway ��(C;-(✓d( Gi� Plan review fee: , �� <br /> `�'�fSH���G Orono, MN 55356 <br /> Total Fee: <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: � (J�/,�S �rn� ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ❑ No <br /> If 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 /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ✓ d ��� �� <br /> State License# ;�v-��7 �� Expiration Date: <br /> Phone: cell �� �l. •���, office <br /> Mailing Address: � {1��, �(� Ci : Q.. ZIP: a� <br /> Contact Person: i �� Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: �fp' � �.2�, ,��,1 <br /> PROPERTY OWNER INFORMATION: r - <br /> Name: _ f�' 0� � L�'li'11-C�-1�- �(J�.�UIn <br /> Phone (day): ' <br /> Address: C4l_4c, 1'��)Y.Q�✓f C1.1'►'►'tS (,1') City• ('��)YlD ZIP� <br /> Email and/or Fax <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$ <br /> ❑New Construction �Single Family with Residence Water Supply <br /> Addition attached garage Gara e/Accesso Bld <br /> ' Accessory Building ❑ Single Family with ❑Deckg ry g' ❑Public Sewer <br /> ❑Refocation detached garage ❑O�ce/Commercial <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse ❑Private Sewer <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 /> Estimated Construction Valuation(excluding land) $ � I� � ��� <br />