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� Z ��� <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: � <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: !�' —�� <br /> Street Address:� Received by: <br /> �y� G� 2750 Kelley Parkway L��� Plan review fee: <br /> Orono, MN 55356 � (� �` <br /> `qkFSHO�� l/�� I• v� <br /> Totai Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> ;;;,: <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: 'U U �/L�' f��' <br /> Will this be a Parade of Homes, Remodelers Showcase Home o other Dis�t y Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL�I,�ANT INFORMA ION: � <br /> ►vame: �t/� ��� t`� ��, /cQ�N <br /> State License# 'Ub (7 Expiration Date: �D <br /> Phone: cell — J -y �C� office —� l D-- 5� c7 <br /> Mailing Address: (�D (p Cit :/Yl/� � � rJZIP: �-�"S35 }` <br /> Contact Person: r /l �?'h Te Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: �� ,� � i`[ C�-t'fe f,c-i f ce�'i✓Y , C D`�' <br /> v <br /> PROPERTY OWNE I FORMATIO�►`�: <br /> Name: �a�r�'y� /1/'A I=S-t'f�-D <br /> Phone (day): l Z—.3��-- O�`57 � <br /> Address: j�S y}'1 �N�1� r Rc,I'E' City�7/1Jq � � /�(� ZIP: �� <br /> Email and/or Fax �� <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: >� <br /> Name: �� <br /> Phone (day): `,� <br /> Address: City: ZI P: <br /> Email and/or Fax: � <br /> ,' <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply P�;; <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 �� M v � �> detached garage ❑ Office/Commercial �Private Sewer <br /> ��Other: (specify) 1 ❑ 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: (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) <br /> $ Q�� C�OC� � <br />