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� <br /> ' CITY OF ORONO <br /> ! BUILDING PERMIT APPLICATION �� � <br /> FOR NEW STRUCTURES OR ADDITIONS I <br /> Mailing Address: Permit number. ��� �'�/ <br /> �0�0' COrysBtai Bay, MN 55323-0066 Date received: �� U-� 7 <br /> Streef Address:' Received by: �� ti � <br /> yF ti 2750 Kelley Parkway Pian review fee: <br /> �� Orono, MN 55356 � � <br /> ���Fs'Ho� T t I Fee� <br /> Main: 952-249-4600 - Fax: 952-249-4616 www.ci.orono.mn.us - �-� -� (�b, g i <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: �OT.•� a�s,�, � <br /> Job Site Address: 7` s ����,� W 1kTcN• ��i J� . � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? QYes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior fo the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficie ite p kin is avaifable. Non-permitted events will not be allowed. <br /> �!oo�� ��►1� �SL11� S �C w t . oG� 1 '?T�!�it�.� <br /> CONTRACTOR/A P�CA INFORMATION: C �J ���� �� <br /> Name: <br /> State License# Expiration Date: <br /> Phone: cell � 0• office • • <br /> Mailing Address. C 1 Cit . IP: <br /> Contact Person: w 1. b` s Applicant is: ontracto Homeowner (Circle One) <br /> Email and/or Fax: �L 6 G <br /> PROPERTY OWNER INFORMA ION: . <br /> Name: � �• � � • <br /> Phone (day): .s ' ' � <br /> Address: Q. Cit : � •wRMZIP: 3y <br /> Email and/or Fax '_' � � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): � � ' V� xi 1�• <br /> Address C �V Ci : i rr �''��"'' ZIP: S S 3�3 <br /> Email and/or Fax: V � CO�+► • <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 [�S�ngle Family with �esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bidg. [,�Pllblic 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 $�ublic Water <br /> zt�iny earkn movement may aiso �zqaire ❑ 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) $ � s� � � � • <br /> 1'tCl.Ci V GL� <br /> Fes o 8 zo» <br /> � cmr oF oRorvo <br />