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i f I'�� <br /> I <br /> ~ � <br /> � I <br /> � <br /> C(TY OF ORONO � <br /> BUILDING PERMIT APPLICATION ' <br /> FOR NEW STRUCTURES OR ADDITIONS ' <br /> , <br /> IA, Mailing Address: <br /> ��'VO PO Box 66 Permit number. �!S-D , 6 � <br /> Crystal Bay,MN 55323-OOfi6 Date received: .3-/7-� S <br /> SfreetAddress:' Received by: � <br /> S'�, � 2750 Kelley Parkway Plan review fee: ��G'?i[i '� , <br /> ��k�SHo��'G Orono,MN 55356 �� ' '�� <br /> Total Fee: ,t� ��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. � (�,�;j �j <br /> Incomplete applicatfons wlll be returned. (Plesse pnnt) � ��- <br /> GENERAL INFORMATION; �' `l�� � <br /> Job Site Address: 2,(0-1� ��(_,._��,( �F�[Z�U,.�(�t� `�{1�� �,'� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth�r Display Home7 Ye No <br /> !/yes,a spec/e/event permlf!s required wfth�olice Departmen�end City Counci!approval 60 days prior to the event. Shuttle bus service wifl be <br /> requlred unless appJfcanf demons[rates suN�cient on-slte parking is avallable. Non-permitted events wl!!not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: 'NI.An�o�Z ��..� Ca._��� C.c N�1'ii-��`i ., ►J !(�L, <br /> State License# L.p U 2�. Expiration Date: �q�� 3��r Zo�� <br /> Phone: ceU Y� -'Z. - tj L office !0 3- �`�'7 ` S Z O <br /> Mailing Address: � 22.5 �U �4V E Ci : A�pl� �iov E Z�p: SS 3 e <br /> Contact Person: D N Applicant is: on ractor / Homeowner �Clrcla One) <br /> Email and/or Fax: �v p �tl� rV cJzE'r� . ('p►�t <br /> PROPERTY OWNER INFORMATION: <br /> Name: STo rJ�C�f��j p� pQ.�rvo �vrV q O rk i n1 i u r�. ` ` <br /> ►4S So C� �T[ o,� <br /> Phone(day): (�1 Z-$ - p O 1 Z <br /> Address: � p ��1\ E r421�W�vJ CitV: OS�Ne ZIP; �j S�3 S 6 <br /> Email and/or Fax �C:f�n�T� �- oTNn.✓..�i�- _ ' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �...�2�tt.. �1C.,� c.1} ; <br /> Phone(day): "j(o� -� d b- �� + <br /> Address: � `7 TH Sr.,T' Cit :'l�/1. �5 ZIP: �S �,Z,. <br /> Emafl and/or Fax: �,�Lpe��� S E�,,,. <br /> PROJECT INFORMATION: Descr' tion of ra ect: ! <br /> 1.Typa of Project 2.Proposed Use 3.5tructure Type 4.Sewage Disposal& i <br /> ❑New Construction � Water Supply j <br /> ❑Single Family with Residence 9 <br /> ❑Addition attached garage ❑Garage/Accessory B�dg. Public Sewer � <br /> ❑Accessory Building ❑ Sfngle Famlly with ❑Deck <br /> ❑Relocation detached garage ❑OfficelCommerciai <br /> �Other;(specify) �CTE121D{L- �Multiple Family/Condo ❑Warehouse ❑Prlvate Sower <br /> '�..STo<<+r'°tJ ❑Public ❑Storage �Public Water <br /> "•Any earth movement may alao requfre ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑Industrial ❑ Private Well <br /> Mfnnehaha Creek Watershed District(MCWD) ❑Other.(specify) <br /> 18202 Minnetonka Blvd <br /> Oeephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471•�682 <br /> i h k. r <br /> Estimated Construction Valuation (excluding land) $ � �. I � � � ` � <br /> . �! <br /> � <br /> d <br /> � <br /> � � <br />