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� � <br /> � , CITY OF ORONO �C�ttvt� <br /> ' BUILDING PERMIT APPLICATION 1�4-�,� � ,� ���� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: ` ' ' <br /> Pe�mit number . '�/^�� <br /> �:-��T PO Box 66 ; <br /> '� Crystal Bay, MN 55323-0066 Date received: � ��—�� <br /> Street Address:' r Received:by: �M— <br /> y.� G"'' 2750 Kelley Parkway � Plan reviewfee: J� � <br /> ��; Orono, MN 55356 � � E _���.� <br /> �9�ESN.� --•-- <br /> ota Fee:� �y �2 <br /> Main: 952-249-4600 = Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application':form must be'completed in full;arid'all required,info�mation must.be:s brriitted; <br /> Incomplete applications wiil'be returned: (P/ease print) ���c� 5�'c��r,� <br /> GENERAL INFORMATION: <br /> Job Site Address: '� � �.,�;�;�rF v� <br /> Wiil 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 Police Department and City Council approval 60 days prio�to the event. Shuttle bus seivice will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: LL%�.c�,��a t� �� ,t_7�F-�S ��C:: <br /> State License# $c:C;�2 y'Z� Expiration Date: 3-3 I -ZG j� <br /> Phone: (celq�,iZ- �,j--3S�i�; (office) 9�1 -�}S-•c�5�3 <br /> Mailing Address: �,t I l 3��� Gitu-L� DF+u� Cit�r:�:aNER:;.;�-A ZIP: 553��3 <br /> Contact Person: lYla rr , v.�R-�:. Applicant is: ontractoc�,� Homeowner (Circle One) <br /> Email and/or Fax: ;-�-,��„rud c� wvc�c ��e.�;: i �.-s . c��'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���r��,� <br /> Phone(day): <br /> Address: City: Z1P: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: � <br /> Name: ��.�:v�� I <br /> Phone(day): i <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 ❑ Singie 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 /> -tAny ear'rn movement rnay aiso�e�i;ire ❑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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � 3 5c�, ���cJ � <br />