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J�3y <br /> CITY OF ORONO <br /> ' BUILDING PERMIT APPLICATION �� , �S <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: c� !3—���9� <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-22 '��� <br /> StreetAddress:' � Received by: <br /> y�, G�' 2750 Kelley Parkwa ��j/ Plan review fee: $ �7� ! � <br /> t�kESHO�� Orono, MN 55356 �I ��3 ,�6 � <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 must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �Q �v i �539� <br /> Will this �e a Parade of Homes, Remodeler Showcase Home or other Dis I Home? ❑ Yes No <br /> lf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic ill b <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP LICANT INFORM TION: <br /> Name: ��,����� � ,t�'�0 iC� <br /> State License# Expiration Date: <br /> Phone: � (cell) (p/- O " N,� office S 2 - / ��Z f�-Qyrt F <br /> Mailing Address: ,��� Cit : <br /> Contact Person: Applicant is: Contractor / HOmeoW� (�irc�e one) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: `�' " � � <br /> �.��� � -_���'�'_�2� <br /> Phone (day): '�=" c�Z 7 <br /> Address: � "� '� - � � Cit : � , ZIP: �- �� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ���'�..� <br /> 1.Type of Project 2. Proposed Use 3.Str t Type 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) CG� �� ❑ 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: (SpeClfy) <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) $��0� , �� <br />