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. � <br /> CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> . - <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: <br /> �-o1Vo PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: I <br /> ( , , �Received by: �.(Y_� <br /> �, ,, Street Address: �d. W �C <br /> s�. � 2750 Kelley Parkway Plan review fee: � �lp � <br /> �qk�,SH���.G` Orono, MN 55356 ��b'�L <br /> Main: 952-249-4600 Total Fee: <br /> 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: ,�G� �rc �-l^ QfZ.G�vU <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> /f yes, a special event permit is required with Po/ice Depariment and City Council approva/60 days prior to the event. Shuttle bus service � be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will noi be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '�tr� .� PIr i �Co��-�'F 2 -- �dn/NE�2� t Mt . <br /> State License# Expiration Date: <br /> Phone: cell office <br /> Mailing Address: Gn. c Cit :� �a IP: �. <br /> Contact Person: ��t�ii..��2 Applicant is: Contractor omeowner ircle One) <br /> Email and/or Fax: ST''cv�� S"tuw,��.Q.IG.. L,oM <br /> PROPERTY OWNER INFORMATION: <br /> Name: (3EN Gs�joOW� � <br /> Phone (day): --��g 22q a'3S� <br /> Address: �.s c,�cAM'- �T City:,b�j�N� ZIP: �'3S� <br /> Email and/or Fax �,q oo caw►�✓�r�u<o bis�-��S _ t,o�1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �F P 1:H cG 2EN S��-� +� D'�.SI 6 N <br /> Phone (day): �`3 , �.{��l . +{�{01 <br /> Address: Cit : ZIP: <br /> Emailand/orFax: ��;� G ne..�.! � ,�c�l:n �-bc�tb�? . t�OM <br /> PROJECT INFORMATION: Description of project: O`�'pdoR R.s�k- R:r'S <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction � Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> �Other: (specify)�'�f�osfl STh��S ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "Any earth movement may also require ❑Commercial ❑ Storage <br /> MCWD review& permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other. (speClfy) '� Othe�(speClfy) <br /> 15320 Minnetonka Blvd ,s-t/�;r-s <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �,�ww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �{a, pts0 . 0 0 <br />