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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �OA f\ MailingAddress: Permitnumber: / —� <br /> � 'V PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: '1/�� <br /> �' Street Address:' Received by: ,(�.d. <br /> 1: � 2750 Kelley Parkway Plan review fee: GDI�G��I/jL - <br /> F L� q <br /> � �, Orono, MN 55356 �/���D 33 f <br /> �kfS H n4� <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��U �oj�� L�/� L�`�l��/�/�i <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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: %�L" � ClfiJ�li�SC-G/-1��: d- � 5/G>/l� <br /> State License# T�C ("p�S'��. Expiration Date: 3- �� - Zc�/-r.�- <br /> Phone: (cell) 7�„3_ �g z � �7� (office) 7��3_ ?�Z . 7�7 7 <br /> Mailing Address: � 'O +�^ iR�c� Cit : �Z-i ZIP: �3 7 <br /> Contact Person: � "� Applicant is: ontractor'` / Homeowner (Circle One) <br /> Email and/or Fax: ���T/L � l:t� !�S/�� i3c.3/L(� C7 j7��• <��^'� - <br /> PROPERTY OWNER INFORMATION: <br /> Name: �7�� �3�Z�'� <br /> Phone (day): 3/'� . �("�, Cp� SCo <br /> Address: G�Vr ,�7ZL:�T ��ft(c.G Ls'4�v��/�lL� City: (��LL-GNC) ZIP: ��j,3(Q <br /> Email and/or Fax '"jo N1 , �}'fZTr1 C�a�u�q <o •"� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �l[/� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�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. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with [:�-Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ,� Other. (specify) �i'1,L IZt��L�� ❑ 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 �Q�� <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���U <br />