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. ' <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> M�BInpAddr�ss: Pertnitnumber: ,G�) ��' � <br /> ��Q PO 8ox 66 Date received: - �" �7 <br /> Crystal Bey,MN 55323-0066 <br /> StreetAddress:' Received by: <br /> y�, `�� 2750 KeYey Parkwe - ���-�(�CJ lan review fee: � <br /> l Orono,MN 56356 �- ---�-_�------ <br /> �k$y�0.� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> T�de appliceticn'fcirit mt�t 6�"t�pl�id�ih t1�arNdap��q�is��rformaRlon must be-s�al�nit�ad. <br /> Incomplete sppllcations w�ll be retumed. (P/ease pr�nt) <br /> GENERAL INFORMATION: <br /> Job Site Address: "'7 L�l�.z ut e.,.J �w <br /> Will this be a Parade of Homes, Remodelers Showcase Home or o play Home? Yes o <br /> I/Wa,a apac/N ev�er�t permR is requfied w1(h Pdkae DeparLnent end CRy Counc�aPl�va�80 daYs Prio►to dre everd. ShulNe bus aervioe wbl <br /> requlred unleas epplkant demonskatea suAkferR on�efle parking k evaAa6le. Na+-pem�Nfed events w�not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Neme: wk�S� <br /> State License# b�- E�cpirat3on Date: <br /> Phone: c�it -t office �. ''F� -o <br /> Mailing Address: C . ��n+� ZIP: 3 <br /> Contact Person: w Applieant is: or / Homeawner 1cra.on•► <br /> Email and/or Pax: ,� :�a- • <br /> PROPERTY OWNER INFORMATION: ' <br /> Name: k �rwrxdit ti1 <br /> Phone(day): • _ lso e � s� � <br /> Addresa: ��,Z,��$ Gc� �a� /� City: l�h�-vw ZIP: `f � <br /> Emaii and/or Fax K� R..� ' <br /> ARCHITECT/ENGIN INFO ATION: �� <br /> Name: �P n'y✓'N � 13•�-S� .�► <br /> Phone(day): o • <br /> Addre6s: C ZIP: <br /> Emeil andlor Fex: � �. -��- <br /> PROJECT INFORMATION: Oesa�i n of ed: <br /> .7yps of Pro�ct 2.Propose Use 3.Structuro Type 4. ewage Dispossl& <br /> Watar Supply <br /> �New Conahudlon �Single Famlly with ❑A�cessory Bldg.!Garege <br /> p� a�ttachod garage ❑Deck ❑Public Se�wer <br /> Q�g��ping ❑ Single Family with ❑Olfice/Commerclal <br /> datachsd ga►age Residence �Pdvate Sewer <br /> �pt�;(�) ❑Multlple FamYy/Condo �Retaining Well(s) <br /> ❑Pubiic 4-feet or greater ❑PubWc Water <br /> "*Any earth movement may also requlro ❑Commercial ❑Storage <br /> MCWD revtew&permits. ❑Industrial ❑Warehouse �Private Well <br /> Minneheha Creek Watershed Diatrict(MCWD) ❑Other(BpeClfy) ❑Other(speCify) <br /> 15320 Mh►natonka Blvd <br /> Minnetonke,MN 55345 <br /> Phone: 952-471-0590 <br /> Fa�c 952�471-0682 <br /> .minnehehecreek, <br /> Estimated Construction Valuation(excluding land) S � �� <br /> Lsat Updeted: January 2018 <br />