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� � � � ` CITY OF ORONO "�'� <br /> BUILDING PERMIT APPLICATION � ��g� <br /> �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: ;;;� <br /> ���0 PO Box 66 ��., Permit number: ��/,s d <br /> Crystal Bay, MN 5532�3-��" � ' Date received: �C— � /„� <br /> StreetAddress:' ' ` '�� � Received by: <br /> W, � :� �� <br /> y � 2750 Kelley Parkway� � 1� !�,� Plan review fee: 75/. 7 <br /> `�t � �' Orono, MN 55356 �i 1( "I <br /> �kfSHO � ��' �� a o� S—�/,3b� <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 mu��,be submitted' <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: y25 L../�/1.���lE V� (���L�V�I�� <br /> Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su(ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: IlJ o�Z.-.TDn1 �jl,,(E� <br /> State License# (�3`�22� Expiration Date: 3 -Z o("'7 <br /> Phone: (cell) �p�� �,;8� — ZCQ�� (office) <br /> Mailing Address: /g � q ' n/ Cit : PL MOJ�-} ZIP: 5544� <br /> Contact Person: C�}�s �,� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: C�4R.-15n�� �118(Z��tb/NE>.Co Nl. <br /> PROPERTY OWNER INFORMATION: <br /> �"7ame: �-�t/�E <br /> Phone (day): <br /> Address: City: ZIP: <br /> ` Email and/or Fax � <br /> � ��� � <br /> �"'�aQ � <br /> ARCHITECT/ ENGINEER INFORMATION: k ,•t , <br /> Name: �K�CG- 1�C-1-}�E�._. U� /� <br /> � D � <br /> Phone (day): �v � �c� <br /> Address: ��1 �j � � ZIP: <br /> l� /�'1 � <br /> Email and/or Fax: � � <br /> % <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use .ype 4. Sewage Disposal& <br /> Water Supply <br /> �New Construction �Single Family with �Residence <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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) � � �(�(��J <br />