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r <br /> � � � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �---_ . <br /> ���O q ,� Mailing Address: Permit number. `'' '� C% <br /> `VO� PO Box 66 <br /> 1� � Crystal Bay, MN 55323-0066 Date received: I <br /> I � Received by: � �-lY1__ <br /> � �, ,, � Street Address:' �d V�% �CC- <br /> � F ` 2750 Kelley Parkway >� Plan review fee: , � ��p , <br /> y � <br /> � <br /> ^ Orono, MN 55356 ������� c � <br /> _----_. <br /> !�rs f��� Main: 952-249�600 ��-- — Total Fee: ""---___w---------'—' y <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) � ;-,r.,-;�,��_;,; °-->� , �����; <br /> GENERAL INFORMATION: <br /> Job Site Address: �G�' C�',t�� �'j' d�a�U <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a special event permit is required with Polrce Department and Ciry Council approval 60 days prior to ihe event. Shuttle bus service i be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N a m e: 'GT�V£ .s P/t� j�C�Cf'-�s� — �-cr/�/�`'�Q� � �C • <br /> State License # Expiration Date: <br /> Phone: cell office <br /> Mailing Address: G.tr. � Cit :�•^.d�a p IP: �. <br /> Contact Person: (� �Fe'���+6,�2 Applicant is: Contractor omeowner ircle One) <br /> Email and/or Fax: S�^�v,E�O g�Cu,��,.��rZ IC.,. [.oN► <br /> PROPERTY OWNER INFORMATION: <br /> Name: (3EN GsC�a 0W� � <br /> Phone (day): -Z�� 22q 6'1 Sb <br /> Address: �.� c�c/��►- �T City:b��u c� ZIP: �'���. <br /> Email and/or Fax �q oo ca�,7►M✓Q r�uto E-�i�T�c.S _ c.d►�1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: '�'���' � 'n, �G 2�tJ �'�A�-� ►.i D'E.51 61�r <br /> Phone (day): �L 3 , �.[� N . �(�{01 <br /> Address: Cit : ZIP: <br /> Email and/orFax: �ti n c� �'Y-►� � ,}c�l:r� �t�c�f 6�? . GoM <br /> PROJECT INFORMATION: Description of project: O`�pdoR R.t�1L ST��rS CCY�"�'c-��-es�' <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)O�DoeQ gT1►��1-,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: (specify) '� Othef(specify) <br /> 15320 Minnetonka Blvd s-(R'��-S <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax 952-471-0682 <br /> v�rfv:�minnehat�acreek or <br /> Estimated Construction Valuation (excluding land) $ �{a, pts0 , o d <br />