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! � <br /> � <br /> � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: - � � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ������� <br /> Street Address:' Received by: ---- <br /> s � 2750 Kelley Parkway � Plan review fee: � � /7 7 .3 7 <br /> `� � Orono, MN 55356 <br /> !q kf S H��F' � / "0� �. <br /> _--_ r__,_ <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ` <br /> This application form must be completed in full and atl required information must�e su m . -� j <br /> Incomplete applications will be returned. (Please print) � t� �L�(,��,� - � <br /> GENERAL INFORMATION: v ��i <br /> Job Site Address: ''�')�-,1�� �h r/e:G� I�� <br /> Will this be a Parade of Homes, Remodelers owcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: , S �-, . L1-� <br /> State License# � Expiration Date: 3 ZU � <br /> Phone: cel Z$ ' ' office "Z- � •- � �, <br /> Mailing Address: Ci : - ZIP: c' ' � <br /> Contact Person: � � Applicant is:, Contractor / Homeowner (Circle One) <br /> Email and/or Fax: S� � <br /> PROPERTY OWNER INFORMATION: <br /> Name: � �.. -k- �,,11r�1 <br /> Phone (day): � (Q , <br /> Address: � Ci : .��.t,�_ ZIP: ��1�� <br /> Email and/or Fax � - <br /> ARCHITECT/ENGINEER INFORMATION: " <br /> Name: `�,�, �(�Y�.t.�i�,- �rl p.�.�'�'�QC_� �S.l� <br /> Phone(day): �- - � <br /> Address: � � c� �: z�P: 55° �� <br /> Email and/or Fax: � t�r�: � <br /> PROJECT INFORMATION: Descri tion of ro'ect: C- .�: . /P /� � / vus t <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Water Supply <br /> New Construction Single Family with �esidence <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 ('�rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) <br /> 18202 Minnetonka B�vd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> 4 <br /> Estimated Construction Valuation (excluding land) $ � �� (�(�O ,�i)p <br />