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• . �� <br /> CITY OF ORONO l��y""�_ � <br /> ��� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS � � /(p .7� <br /> O Mailing Address: Permit number: 070/3 -' Od"7� <br /> PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: �D `��"�.3 <br /> Street Address:' Received by: S <br /> y ` 2750 Kelley Parkway Plan review fee: 3�7 z � �' <br /> `�tq �,�' Orono, MN 55356 �D/3 _ p4 � <br /> KFSHO� 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: � 1 �� � �� �.� L , ,:� �. � � c�c� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [i]�ids <br /> If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT INFORMATION: <br /> Name: �'�� u � � ��,,.._ L�� �s � <br /> State License# � �. y� ;} � �� Expiration Date: 3 --3 1 -j� <br /> Phone: (cell) �, , � _ � ;� � ��, c� � (office) <br /> Mailing Address: � , � ,� Cit : _� ZIP: "' a <br /> Contact Person: Yl� .� j Applicant is: on ract / Homeowner (Circle One) <br /> Email and/or Fax: ��.� � � A� 1< ,,,,r�'J� Cu..,., � ✓� S ��� w��{- ��—G�� - 4 5 y .•(..•5 �4 <br /> PROPERTY OWNER INFORMATION: <br /> Name: S f-� �..2 L�� I< ,�. r� � S o .. r� 1�-� � sc„_ <br /> Phone (day): C� — � 7 �,— p�, 7 � � <br /> Address: 1 � ��' L c.� �-� t.., � � -e 12 ���;� City: v�a�� 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. Structure Type 4.Sewage Disposal & <br /> �K+��� �� � � Water Supply <br /> ❑ New Construction • ingle Family with Residence <br /> ❑Addition �2 f1 L��� � attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building G-���� � Single Family with ❑ Deck <br /> ❑ Relocation 1 � �`� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [�6ther: (specify) �8— t � ❑ Multiple Family/Condo ❑Warehouse <br /> ( ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may als require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�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) $ �� �� � n0 � <br />