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, CITY OF ORONO �. <br /> , BUILDING PERMIT APPLICATION c� �(.p�' <br /> FOR NEW STRUCTURES OR ADDITIONS� <br /> /�O A,\ Mailing Address: Permit number: , '"�`/� ^ <br /> 'VO\ PO Box 66 <br /> / � Crystal Bay, MN 55323-0066 Date received: . `��/ <br /> � ' � �- C,� _ � Received by: � �. �%� <br /> � ,, Street Address:' ,�.,� <br /> y '� '�� 2750 Kelley Parkway U��� • �� + 1 n review fee: �_��� �� . <br /> F L� <br /> lqKfsHo�� �� Orono, MN 55356 <br /> �-�/ lp�� Main: 952-249-4600 Total Fee: <br /> 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 applicatlons will be returned. (Please print) <br /> GENERAL INFORMATION: /� <br /> Job Site Address: y S `�O � <br /> t.v, , �1a2, L-D'J� �--� . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to tha event. Shuttle bus servrce will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be alfowed. <br /> CONTRACTOR/AP LICANT INFORMATION: <br /> � <br /> Name: :�r�� , � c r.c . <br /> State License# ' � 3`}6i�c-- Expiration Date: '� � �� <br /> Phone: cell Z, 2:, ' office <br /> Mailing Address: 41�( Cit : ,-h.�,, ZIP: ' <br /> Contact Person: � c,� ^ �,� �- ,,� Applicant is: n rac / Homeowner <br /> (Cirde One) <br /> Email and/or Fax: _ � . < r.� <br /> PROPERTY OWNER �FORMATION: <br /> Name: qn.C��rr, � ZPa� v,�.���«�P�r <br /> Phone(daY)� L��I{) �lG r�ri(�l� (� ��- �Q rv�. <br /> Address: L�<;�;:;�;�: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: CitV: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: lv.r e Q�c,S-t;�,�� �.c:.� z,. ���:.� Jr,�-c,,�� �'�,� <br /> 1.Type of Project 2. Proposed Use 3.Structure Ty 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage �Deck 18 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> �Other: (specify) ��L'��J ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public 4-feet or greater � Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.mfnnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ �., a� <br />