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1 —! <br /> � �-� -3 - t 3 �. . �,. <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �l –��8 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �i–o?�,�.3 <br /> Street Address:' Received by: <br /> y�, G� 2750 Kelley Parkway Plan review fee� <br /> `�KESH��� Orono, MN 55356 <br /> Total Fee: � �j o�« (v� <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: � � �-� �o � S•�,��-� :, � ��� ,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er Displ y 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 I APPLICA�T INFORMATION: <br /> Name: �I �Uv�t� <br /> State License# �— Expiration Date: <br /> Phone: (cell) �S�• �rl'1- '� 0�7 I (office) �� �-_, <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: / <br /> Name: �ru D-�� �;.,( �t�y ��t�l'<� <br /> Phone (day): 5�� �'��- �o� i <br /> Address: a 3D x Cit : ZIP: S <br /> Email and/or Fax � " � ��� �• � �; , ,n <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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: Sp Cify) <br /> 18202 Minnetonka Blvd ; <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 � I � <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> ; <br /> Estimated Construction Valuation (exduding land) $ ��vU � <br />