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= CITY OF ORONO <br /> . <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: a 0��—� � � <br /> ��nj PO Box 66 _� <br /> � Crystal Bay,MN 55323-0066 Date received: �� � <br /> Street Address:' Received by: <br /> y � 2750 Kelley Parkwa review fee: <br /> F� L� Orono, MN 55356 Q� �6/ � <br /> �KfSHQ�� a ee: p <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � � 7 �. 3 / _i� <br /> This application form must be completed in full and all required information must be s bmi . <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORMATION: I,�� � � � 2Z <br /> Job Site Address: J <br /> Will this be a Parade of Homes, Remodelers Sh case Home or other Displa Home? Yes � No <br /> !f yes,a specia/event permit is requfred with Police Department and City Council approva160 days prior to the evenf. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC NT INFO ATIO : �� <br /> Name: 1� <br /> State License# Expiration Date: � <br /> Phone: cell office <br /> Mailing Address: — Ci : • ZIP: �5(�) <br /> Contact Person: � ' Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: S <br /> PROPERTY OWNER NFO�MATIO : .�� , <br /> Name: ► bl.� <br /> Phone (day): 2' — � <br /> Address: �� Ci : �} � Z�P: , ��1 <br /> Email andlor Fax � � � � <br /> ARCHITECT/ENGII�EER INF RMATION: <br /> , <br /> Name: — <br /> Phone (day): 7--� - � <br /> Address: Ci : YL ZIP: -rj ' <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: I� �n�e �nn�� <br /> 1.Type of Project 2. Pr osed Use 3.Stru ture Type 4.Sewage Disposal8� <br /> Water Supply <br /> [V�New Construction Single Family with �esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. dPublic 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 8 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ZZS�U(.i�'UU - <br />