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e <br /> / :_-- <br /> CITY OF ORONO � <br /> BUILDING PERMIT APPLICATIO / <br /> �� �' % <br /> ,- <br /> ,_ , <br /> FOR NEW STRUCTURES OR ADD1T1 '-- � <br /> �O A jO Mailing Address: Permit number: O - ��oZ� <br /> �V PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �Q-1 -/ <br /> � � <br /> StreetAddress:' Cj`�p�l�� Received by: -� <br /> F � 2750 Kelley Parkway Plan review fe� p,)���� /e2LLS <br /> t � Orono, MN 55356 <br /> �k�SH���� Total Fee: 3� � � <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 appiications wiil be returned. (Ptease pnnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: �s"��� �Z����f,,,` �LL /2,c� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes, a special event permit is required with Po/ice Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR f APPLICANT tNFORMATiON: <br /> Name: � <11-�5 ��-'n�/ �/�Z�S', ��t/C�> <br /> State License# T����b��c!y' ' Expiration Date: <br /> Phone: (cell? �vlZ-7��3 -5�r� (office) 15�' - �7S—6 7 7 7 <br /> Mailing Address: �L(/i1 G✓ �'i`� Cit : G�J�! L.��f'ZIP: �53``-✓J <br /> Contact Person: y� ;� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � <br /> /� � �,�cc i`t�f crHc�� <<'or�2 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �v,3 •-! l��x�2T.i��7 ��� <br /> Phone (day): <br /> Address: _ �,qy��� City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: FI'l�?-�� y�t�tlK�� <br /> Phone (day): <br /> Address: City: 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 /> ❑ New Construction ❑Single Family with ❑ Residence <br /> ❑Addition attached garage �,Garage/Accessory Bldg. ❑ Public Sewer <br /> J8 Accessory Builcling ❑ Single Family wnth ❑ 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 <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (speCify) <br /> 18202 Minnetonka Blvd �/�„y,�� �LY¢lZ�.i <br /> Deephaven, MN 55391 � <br /> Phone: 952-471-0590 � ��"�R�(f"`�'y'"�1 <br /> Fax 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 3r� <br />