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. S ���,�� <br /> . ��� �3�� <br /> Q CITY OF ORONO <br /> BUILDING PERMIT APPLICATION �05-�- <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: ' <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � !3 <br /> StreetAddress:' Received by: �_-� <br /> y� G� 2750 Kelley Parkway Plan review fee: <br /> �� <br /> Orono, MN 55356 ��J�r_�� q� <br /> �'�ESH� 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. (P/ease print) <br /> GENERAL INFORMATION: ' <br /> Job Site Address: (� ����� ���;� ���� i�Gt ���� �1 �GtV1G�:�� � �1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display 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 6us service wil!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: �'da� ��je��- <br /> State License# Expiration Date: <br /> Phone: cell Fi — � office <br /> Mailing Address: �'O i fv�l� i �+ c /.t z Cit : /D�t o ZIP: " � 6 <br /> Contact Person: � ; ,/,�( ��r�� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: - ��-,����/�i����-r},u�;^" <br /> r, �� <br />�; PROPERTY OWNER INFQRMATION: � �)(?�� <br /> Name: �;�; , � <br /> Phone (day): �,_ �� - `�� � 3�: 5 � <br /> Address: '� ,^ "f�j �� �� ���.�; ���/,'�= Cit �'; � �;; ZIP: � <br /> Email and/or Fax ;� � � �� � � 7-;�yc7. ;;:�;rv� <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �� j � ��, i� G'�<. 1���t r c� <br /> Phone (daY)� ���a..� �G 1 �� �3 6l , � "' ,, _-. <br /> Address: G��'�G ��/�J�n r�J✓� �'✓ City: "` ��� �e I� ZIP: S�G��;� <br /> Email and/or Fax: � �i.;--���'� <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <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 eck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> '�Other: (specify) ;r�`��C .���, ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial �rivate 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.min nehahacreek.or <br /> $ =--�'�. . „ ,. <br /> Estimated Construction Valuation (excluding land) .J__�' �. _- ,' <br />