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� '�� CITY OF ORONO ���� ��� <br /> . t <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O MailingAddress: Permitnumber: ��� -�0�� <br /> PO Box 66 � <br /> � � Crystal Bay, MN 55323-0066 Date received: �"��- � <br /> StreetAddress:' Receivedby: iil � <br /> y�, � 2750 Kelley Parkway l�ly,I�'� Plan review fee: � �7$•g� <br /> lqkESH���,C' Orono, MN 55356 `���� �i3_ �i�3 <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: " �� v �.._ � , . <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 Ciry 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: R�v�..�rf -� �;� „f' e-,��f �,� -zs .a-;-�c <br /> State License# 3G �,���,� Expiration Date: �/�;���� `�; <br /> Phone: (cell) ���yc�� i����� (office) -' �/� � �����I,3� <br /> Mailing Address: � � - Cit : � ZIP: 5�3�� <br /> Contact Person: �yi�,z��;� i�:�.�A L Applicant is: Contract�/ Homeowner (Circle One) <br /> Email and/or Fax. ��c��- S j �-- �/ c�� p�.-t �� �c c'�hr �,r~ � C^/-' c��� � � �• .Yl <br /> PROPERTY OWNER INFORMATION: <br /> Name: �D��,��rc �_J-��m� f_�-r�,z«-,z�� �,-�c . <br /> Phone (day): ��,3 yc����,�s <br /> Address: 1L�� �..�,�y�_;-�=, ���� �-� � C}; �= � �� CitY� �.;,�-;z,��,-:� ZIP: �`� 3�, / <br /> Email and/or Fax <br /> �ARCHITECT/ENGINEER INFORMATION: <br /> Name: �-��-� Z 7 r�ir -�; <br /> Phone (daY)� ��5,� - C�q��-1-�^E �,� <br /> Address: City: ZIP: <br /> Email and/or Fax: Ml K'� � r� �3� �-+ 2��Z�r�,,� C�A,v :��y�,�. �_.��.-�r-� <br /> PROJECT INFORMATION: Description of project: ��.-�` � ,�� -�t� � � �. � <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ew Construction �ingle Family with �esidence <br /> Addition attached garage ❑ Garage/Accessory Bldg. �ublic 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 �'ublic 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) $ ����,pZi'� <br />