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_ � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��,. `O Mailing Address: Permit number: �/ �(,� <br /> Iv PO Box 66 / <br /> Crystal Bay, MN 55323-0066 Date received: : cP�� —� <br /> StreetAddress:' Received by: <br /> y�, � 2750 Kelley Parkway Plan review fee: � �l. �T <br /> L Orono, MN 55356 <br /> �'kESHo��' ��/ �_� 40 <br /> Totaf Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form mus#be completed in full and all required information must be subrnitted. <br /> Incomplete applications will be retu�ned, (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: q �, ` � <br /> Will this be a Parade of Homes, Remotlelers Showcase Home or other Display Home? ❑ Yes o <br /> ffyes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/ PLICANT INFORMATION: <br /> Name: ►'�CjS101'1 ��IC.S LLG <br /> State License# � Expiration Date: I <br /> Phone: ce�l -2,Z - q office -3 5"�)Z33 <br /> Mailing Address: Ci : ZIP: <br /> Contact Person: Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: ObE..° YYl <br /> PROPERTY OWNER INFORMATION: <br /> Name: � <br /> Phone (day): — -� 2 <br /> Address: 2 e c� : ziP: 55331 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 Disposal8 <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑ Residence <br /> ddition 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 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �I ,� <br />