Laserfiche WebLink
Jun 14 13 1z: 23a Dupont Construction 763-413-2614 p. 2 <br /> , , j� ��-I.� <br /> s� � <br /> � ���� � <br /> CITY OF ORONO �.yt� �� �. <br /> BUILDING PERMIT APPLICATION � ,J� ��j�I I <br /> FOR NEW STRUCTURES �R ADDITIONS <br /> �-' Maifing Address: Permit number. Q � — � <br /> / ¢�n/ � PO Box 66 <br /> � Crystal Bay, MN 55323-0066 � Date received �p 'I �v 13 <br /> � � Street Address ' Received by: � � <br /> 2750 Kelley Parkway Plan review fee: �`"► �-7-� <br /> '�.F�� . ����,' Orono, MN 55356 �p�3 —� 07' <br /> '. �L�r�`� Total Fee: <br /> - - <br /> -- <br /> Main: 952-249-4600 Fax. 952-249-4616 �,;, � �.�:��� � ..- <br /> — __ --- <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please prinfJ <br /> GENERAL INFORMATION: <br /> Job Site Address: Q �� <br /> Wlf this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lfyes,a special event permd is required with Polrce Department and Criy CouncN approva!60 days priorto the event. Shuttle bus service iU be <br /> r�puired unless applicant demonstrates sufficien[on-site parking is ava�laple. Non-permitted events wiJi not be alfowed. <br /> CONTRACTOR/APPLICANT INFORMATION: !1 . <br /> Name: ��p�y1t�YY7�RVf r• �,LY1�( f�in(X�,L�IYIsn <br /> -� State L.icense# _ _` Expiration Date: <br /> Phone: (cell)tp��, I�ej ')�7� (office) "��p? �/5� G��G(�P <br /> Mailing Address a�jj (,�����,�55 �"� C-�� Cit : = Gt,S ZIP:�'..yS�`� <br /> Contact Person: � � -�- Appkicant is ontractor 1 Homeowner (CircleOne) <br /> Email and/or Fax: i)n ��S'i'RVLs•I�+17Y1 @ f�Y4�'��U3� <br /> PROPERTY OWNER INFORMA710N: <br /> Name: _ <br /> Phone(day}: - L l <br /> Address: Cit : _ ZIP: �j 3 j(,�__ <br /> Email andJor Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day}: ___ <br /> Address: City: _�� ZIP: <br /> Email and/or Fax: <br /> n ` ' '(' S t�rs <br /> PROJECT INFQRMATION: Descri tion of ro ect: [7�%1 � 0� � �C � l� `L � irY� IJ t W d,r•g-I-a <br /> 9.Type of Project 2. Proposed Use 3.Structure Type i 4. Sewage Disposal& Q c��� <br /> j Water Suppty <br /> ! ❑New Construction Single Family with ❑ Residence ��� <br /> Addition attached garage ❑Garage!Accessory Bldg ❑ Public 5ewet <br /> Accessory Building � ❑ S�ngle Family with Deck �d�'�h �� <br /> ❑Relocation � detached garage �OfficelCommercia; ❑ Private Sewer -�,� �� <br /> ❑Othee(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. IJ Industrial � ❑Private Well <br /> Minnehaha Creek Watcrshed District(MCWD) ❑Other: (specify) I <br /> 18202 Minne[onka Bivd i <br /> Deephaven, MN 55391 � <br /> Phone: 95Z-471-05yU ! <br /> Fax: 952-a71-0682 �� <br /> ,i�. <<. <br /> Estimated Construction valuation (excluding land) $ _���5��1 d�� <br />