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' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number: �0 !/ <br /> PO Box 66 <br /> � � Crystal t3ay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� L Orono, MN 55356 <br /> �qkESHn��`� Total Fec: � Qg9 � <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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: ���� <br /> Job Site Address: ���n ��ey At21�-l.t.�4��) <br /> Will this be a Parade of Homes, Remode rs Showcase ome or other Display Home? ❑ Yes <br /> !i yes,a special event permit is required with Pnlrce Department and City Council approva!60 days prior to the event. Shuttle bus servfce will� <br /> required unless applicanl domonstrates su/ficient on-site parking is available. Nnn-permitled events will not be allowed. <br /> CONTRACTOR I AP�j LICANT INFORMATION: 1�_ <br /> Name: / �-�r C�' f.�[LQ11�Q ���IL Al2�^14t�BM.T _--- <br /> State License# ��- Expiration Date: <br /> Phone: cell office �Z �' ���(NV _..__ <br /> Mailing Address: L Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / e f (Circie One) <br /> Email and/or Fax: __ <br /> PROPERTY OWNER�N FORMATION: <br /> Name: C.I� 0� I�IZJMv � .�G��U4 �,OP�h.tS � I -- <br /> Phone(day): QSZ- 2 __� <br /> Address: Cit : ZIP: _ <br /> Email andlor Fax lA � � <br /> ARCHITECT I ENGINEER INFORMATI N: <br /> Name: �L � C. _ __. <br /> Phone(day): _��S{1 - 1 <br /> Address: 0 ' f} Cit : Ol�.� �P� ��� <br /> Email and/or Fax: ry_��p �1]MLth��kc� �� <br /> PROJECT INFORMATION: Descri tion of pro ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewaqe Disposai 8 <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> �Addition attachad garage �arage I Accessory Bldg. �Public Se.wer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation . , detached garage �Office/Commercial ❑ Private Sewer <br /> �ther.(specify) (�GICL- �e1tA�'�rrM ❑ Multiple Family/Condo Warehouse <br /> �Publlc ❑ 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) �O 1er:(SpeGify) <br /> 18202 Minnetonka Blvd � <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.rninnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ �"��33 � v�0 1� <br />