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._. CITY OF ORONO <br /> • BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: <br /> �O�O PO Box 66 Permit number: _ 7/ � —(��� <br /> Crystal Bay, MN 55323-0066 Date received: �-- � �—�� <br /> Street Address:' Received by: <br /> � ------------ <br /> y� G� 2750 Kelley Park ay2 L �(� —(��g'2 Plan review fee: 3 �8 3. � <br /> qKESHOR� Orono, MN 5535 s <br /> Total Fee: <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: �,5 (,�c/LC VIG� Cct/'►�l� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> lf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shu le 6us service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: `UQr'�j �ornt5, LLG <br /> State License# L3G G39�a-/ Expiration Date: ,j-�/-J�] <br /> Phone: cell /Z- b- office 7 G3-,�$Y1-�9`�� <br /> Mailing Address: S�' �, N• S �. Ci • � <br /> dv ZIP: s <br /> Contact Person: i5 No� Applican± is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: Ch ' .C �fv3•SS — <br /> PROPERTY OWNER INFORMATION: <br /> Name: .SOII�[G�Q.f'le� Q°VP�d1�/'�7� <br /> Phone (day): . ,$ /• n/ d <br /> Address: ( �+ , /�/ ,d Cit : � /71 ZIP: SSYY� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEFR INFORMATIO : /�,,` ��` <br /> Name: JGi,I'I?�J %I')GN�°� r/�(,�jr1CP.�'tN� ,`vei5lRh <br /> Phone (day): (�-q70 • �3g�g <br /> Address: OSO � N Cit : � /rjdv�'j-, ZIP: ,sf <br /> Email and/or Fax: 1G1�i'!'1 eS�LG/1�ea.� �C dv c o <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 �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.min nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � ����'I�"fCj <br />