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. ' � � � 2� 3 . , <br /> ; <br /> CITY OF ORONO � <br /> BUlLDING PERMIT APPLICATI4N �: <br /> FOR NEW STRUCTURES OR ADDITfONS <br /> O MsFling Address: Permit number. o��/3 —�U �/ <br /> PO Box 6fi <br /> � � Crystal Bay,MN 55323-OOf:6 Date received: Z ��� �`3 <br /> SbaetAddress:' Received by: . <br /> y ��" 2780 Kelley Parkway Plen review fee� 0 3-Ov �/Z� <br /> `�t,�kas�o�w�' Orono,MN 55356 � Q fca. �9 , <br /> Total Fee: � <br /> ' Main; 852-249-4800 Fa�c 952-249-4816 yvww.ci.orano,mn,us <br /> This application foRn must be completed in full and all requlred informatlon muat be submltted. <br /> Incomplete epplicatlans will be returned. (Please p�lnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: � � r7 � /Vl�l�,� � ��IGC, <br /> 1MII this be a Parade of Homes, Rerrtodelers Showcase Home or other Dlsplay Home? Yes No <br /> 11 yes,a spedal evant permlt!s requlred wfthh Aolfoe Deparfinent end Clly Coumm:lll approve!80 days prfor fo the event. Shuttle bus servlce wl!!be <br /> raqulred unfess sppJlcant demonsfratea suAtclent orrsRe parklrrg!s avelleble. Non-permltted events w!!1 not be ellowed. • <br /> ' , � <br /> CON1'RAC70R 1 APPLI ANT INFORMATION: <br /> Name: � q I o�3 <br /> 5tate License# G ���1 f��b�, �Expiratlon bate: 0 2-�r�' <br /> Phone: cell ��1 I �(o office '1 b3 H 2 3 3 3 <br /> Mafling Address: � ��'.� ,re, CI • ZIP: � <br /> Contact Person: r. ' Applicant is: Contractor I Homeowner (Clrale OneJ <br /> Emell and/or Fax: �I� � .caw�, � o0 <br /> PROPERTY OWNER INFORMATION: � ,/� �L� <br /> Neme: �"1 r-� �G�-c <br /> Phone(dey): __]� 2�01! • � • p <br /> Add1'ess: t�(HG G1� s�r 5� �-t l!v� 5 kev<.��►�itQ: �p✓,�1�j -in/ z�P: �;5 3 0� <br /> Email andlor Fax 'j�, 3 � StaS' 2�0 2.. <br /> ARCHITECT 1 ENGINEER INPORMATI01�• <br /> Name: (��-{� G v i����i�h. <br /> Phone(day): ti o 7 - q� - �13� <br /> Address: g��,,.�,.�o0 0� City: Z1P; <br /> Email andlo�Fax: D s S�o M S'S3�`l <br /> PROJECT INFORMATION: Descn tfon of ro ect: <br /> 4.Type of P�oject 2.Propoaed Use 3.3tructure Type 4.Sewage Dleposal & <br /> Water Supply <br /> �New Constructlon �J Single Family with �Rasldance <br /> Addition � ' attached garage Garaga/Accessory Bldg. �'Public Sewar <br /> ❑Accessary Bul[ding • ❑ Single Famfly with ❑Deck <br /> ❑RelocaUon demched garage ❑Otf�ce/Commerdal ❑Private 5ewer <br /> ❑Oiher.(specify) ❑MulBple Fam(ly/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Pubiic Water <br /> "'Any earth movement may a18o tequfre ❑Comrt►erclal ❑Other{specify} <br /> MCWD revfew&permits. ❑Industrial �P�ivate Well <br /> Minnehaha Creek Waterehed Diatdct(MCWD) ❑Other:{apecity) <br /> 18202 Minneto�ka Blvd <br /> Deepheven,MN 55391 <br /> Phone: 852-475-0590 <br /> Fax: 852-471-OBB2 <br /> 0 <br /> EsGmated Construction Valuatlon(excluding land) $ ��`7� 000 . �ZJ <br /> 7` <br />