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� a , � <br /> - CITY OF ORONO �j � � <br /> BUILDING PERMIT APPLICATION i i�(� <br /> FOR NEW STRUCTURES OR ADDITIONS �I <br /> OA, Mailing Address: aQ�7, _�� C� <br /> � (VO <br /> PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: �—��o / <br /> Sfreet Address:� Received by: f� � <br /> y G� 2750 Kelley Parkway Plan review fee: +� � 7 l� �Z3 <br /> `�t Orono, MN 55356 <br /> tt / <br /> qk�'SHO � Total Fee: 3—�� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orcno.mn.us <br /> This application form must be completed in full and all required information must be submitted. �� a5 �� <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �,J�L <br /> Will this be a Parade of Homes, Remodelers Showcase H me or ot er 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 ill 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: <br /> State License# Ex iration Date: l <br /> Phone: ceil � . office <br /> Mailing Address: Cit � ZIP: <br /> Contact Person: Applicant is: Co trac or / Homeowner (Circle One) <br /> Email and/or Fax: �nh��� �C�,� <br /> PROPERTY OWNE INFOR TION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> 1 <br /> ARCHITECT/ENGINEER I FORMATION: <br /> Name: ��„n � <br /> Phone (day): � �1d7 <br /> Address: Cit ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �ew Construction �ingle 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&permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �wwv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �Y'�, � <br />