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� <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ,�., Mailing Address: Permit number: � �'� 7 - ' ?< < �] <br /> , PO Box 66 _ <br /> �` � Crystal Bay, MN 55323-0066 Date received: -` <br /> �` Street Address:' Received by: f-S <br /> \ti �/ 2750 Kelley Parkway ,�--'" � Plan review f e: � <br /> ��r'�KxyH���.�f Orono, MN 55356 < �\ �� ��j(,f.�j n � (1�� . <br /> ���..``/ Main: 952-249-4600 ��. ��----- a ee: --� --- — <br /> �� __ -r�-��------- 3 �i <br /> Fax: 952-249-4616 www.ci.orono.mn.us �f� . <br /> This application form must be completed in full and all required information must be su mitted. i . <br /> Incomplete applications will be returned. (Please print) "`"���"s� <br /> GENERAL INFORMATION: A ' }11�� ��� <br /> Job Site Address: ;� a�2� 1V Au �� ' , L- L1 <br /> 1/Vill this be a Parade of Homes, Remodelers Showcase Home r 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 bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR�TION: <br /> Name: L� �3 � � �-1 '�' , <br /> State License# Expiration Date: <br /> Phone: cell S �D � office � <br /> Mailing Address: i� �f� Cit : �" 1,� ZIP: � � <br /> Contact Person: m J� A plicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: L la �� ��C �� i L�iDc�� . CO � <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��� '� � � 'L, <br /> Phone(day): S 2- n <br /> Address: � ' �Q -2� Cit : I ��� � ZIP: � S � <br /> Email and/or Fax C��3���� �"",� �e O� . c �oM <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> �r1/-� C� ;__/ �c- � f�' ' c� �� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction [�Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage Deck �Public Sewer <br /> r.cessory Building ❑ Single Family with OfficelCommercial <br /> Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater �Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MIV 55345 <br /> Phone: 952-471-0590 <br /> Fax. 952-471-0682 <br /> www minnehahacreek.or <br /> r��, <br /> Estimated Construction Valuation (excluding land) $ ,�i � F /� ` <br />