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�, � �5 �oZ� <br /> � � <br /> CITY OF ORON ���� � ,� �j�P' <br /> BUILDING PERMIT APPLICATION � � � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: 07 D I`-�— D�7J� <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 ` t � Date received: 7-��0-�� <br /> , '� � ; <br /> Street Address:' � ,� � Received by: S �r <br /> y� �' 2750 Kelley Parkway P' ,�, Plan review fee: ��� -�U � <br /> �' Orono, MN 55356 <br /> �qkESH°�� Total Fee: �� � g� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us e(,'d $�Z•��► <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: I <br /> Job Site Address: � /ti�� � u��c�c�C4 C>�d�'`O � S �`1 � <br /> Will this be a Parade of Homes, Re odelers Showcase Home or other Display Home? ❑ Yes , No <br /> If yes, a special 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: i o( i <br /> State License# Expiration Date: - - <br /> Phone: (cell) /02— �- oy8a (office) <br /> Mailing Address: l5 /�'�vr�,p�oa,l fZo( - City: �it�i'�-G ZIP: $�S3q / ;. <br /> Contact Person: ���c�,.�,Qswea�L.e►�� Applicant is: Contractor / Homeowner (CircleOne) � <br /> Email and/or Fax: �i.,;Jc,rn,e�we�;�}-�ers � r�a;�- ���,.�.-; <br /> PROPERTY OWNER INFORMATION: <br /> Name: (�v�ih Z�S . ��'CNl� �. Ac1'1vU� I��(QV� <br /> Phone (day): <br /> Address: �s M�'/' �(�� � 2 c^�(- City: G` Y Cs1�.C3 ZIP: S 5 3 � � <br /> Email and/or Fax Si'�•(pf1�� };f : Ol,t'? . :�� <br /> ---��� <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: � �c�C� ��i�v �a �' ��r� �ni��� <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) <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 /> � G� <br /> Estimated Construction Valuation (excluding land) $ � �o,���J <br />