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. � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION �57- <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Add�ss: Permit number: o�b� —D/�/ <br /> �- �TO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ���� <br /> Street Address:' Received by: <br /> y � 2750 Keiley Parkway Plan review fee: �6� 7� <br /> `� L Orono, MN 55356 / <br /> `�KESHO�� Total Fee: a�/y `� <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: `�`7 �� � L�n� �., - �✓\ ' � � 3 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Di lay ome? ❑ Yes �-No <br /> If yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle 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/APP I ANT INFO,�tMATION: <br /> Name: ����,✓ f,,✓ <br /> State License# Expiration Date: <br /> Phone: cell , ,�- - - office <br /> Mailing Address: ' �� o�e� +�n�� (� Cit : =>r��,� ZIP: �- <br /> Contact Person: �"�F-(= ,a��� Applicant is: ontractor Homeowner (Circle One) ;?, <br /> Email and/or Fax: .,.j���rC�, ��-�r����y_�,,(��u.1 `� <br /> � <br /> PROPERTY OWNER INFOI2MATION: <br /> Name: -� �� <br /> Phone (day): ''��-��-{,'L 2-_33:�""1 <br /> Address: Cit : Q!`t7✓�� ZIP: _ <br /> Email and/or Fax �j�,r,r�,�� p r7,�-�ic./"� Y� , ,{a,r,-F-- <br /> ARCHITECT/ENGINEER INFORMATION: , <br /> Name: � %r ' ��,:�y.� <br /> Phone (day): 31c�— �— � ZIP: `����J� <br /> Address: '��p E--Fc�.;U l,c� `�DcA��r-�� City:� ,('(�U.,� - <br /> Email and/or Fax: ��—���_�,�;�� - <br /> � <br /> PROJECT INFORMATION: Descri tion of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> `*Any earth movement may also require ❑ Commercial [] Other(specify) x; <br /> MCWD review 8�permits. ndustrial �a,,n,�-�c (r/i ❑ Private Well �; <br /> Minnehaha Creek Watershed District(MCWD) �f Other.�specify� <br /> 18202 Minnetonka Blvd �,n,/Y /ii/;�.(� <br /> Deephaven, MN 55391 �' <br /> Phone: 952-471-0590 ';F <br /> Fax: 952-471-0682 >`;k <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � ��� . �v <br /> I � : � ._` <br /> � � v,.�.� � <br /> �t , .. . ,_ . ._. .__. �:.� <br />