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F• <br /> CITY OF ORONO <br /> , BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: o�Q� �o —�/o? <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> � G� 2750 Kelley Parkway (�i� �83 , � <br /> �' Plan review fee: <br /> �1�kESH��� Orono, MN 55356 � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 7(J � V/�-w �C�,,��(cH/ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe isplay Home? ❑ Yes No <br /> /f yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service wi be <br /> required unless applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO ATION: <br /> Name: �/Or''-I� dn7� uC <br /> State License# �G �c, 9 a-1� Expiration Date: - /- / 7 <br /> Phone: (cell ly- (�- 7!P!o� (office 7�i3•SS ��- 9/ <br /> Mailing Address: ,N► N S�C, Q Cit : ZIP: .SsSIY <br /> Contact Person: Ch r�S No►"�a�.� Applicant is: tractor Homeowner (Circle One) <br /> Email and/or Fax: G17r'1 S rt�� nor�4ar� �1vr+eC cc�-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,�� /'YI <br /> Phone (day): (i� 1-'7 Sb '�0 <br /> Address: 0 'd � Cit : C�YC'C/fco�r-� ZIP: SS3`�(� <br /> Email and/or Fax � n Y . <br /> ARCHITECT/ENGINEER INFORMATION: • , <br /> Name: Ja,rn cS /1'Lc..l'�1e� �7L�I1 /� " �3t9n <br /> Phone (day): (.i f 1�q�j0 ' b3�' <br /> Address: jSOSO �3r' /9-✓L �1 City: P��f/'yj�T� ZIP: S�Y� <br /> Email and/or Fax: JG�rn.eS m c-l�{ /C 0 c c�v� <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <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 �rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (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) � `�OD_O d�..D� <br />