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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: o?8( —�d '!J' � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-00 6 Date received: <br /> Street Address:' Received by: <br /> y� ` 2750 Kelley Parkway �'��'� Plan review f <br /> � Orono, MN 55356 <br /> `�'�FSH��� ' �� .�� <br /> 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: i 3 �- ���%�'��- ,��'� �r'�V� C���c�✓�o �'�� � S ��`� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home. ❑ Yes o <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/A LICANT INFORMATION: \ <br /> Name: �c�v��� l �S`'1-�.e l cJ <br /> State License# Expiration Date: <br /> Phone: cell ' — �gj'} - office <br /> Mailing Address: l � � G�c�r¢ ' � Cit : Vl O _.__._1.IP: � ��t <br /> Contact Person: � `te l'1 Applicant is: Contractor Homeowne?��_�ircle One) <br /> Email and/or Fax: r . � t , tA <br /> PROPERTY OWNER INFORMATION: <br /> Name: �«v1i�� �1�v1-�Q�� <br /> Phone(day): cP 1Z— � �� —C�3 <br /> Address: / � �'v�L � Cit : ZIP: <br /> Email and/or Fax ' , Gt.s r . CO W� <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <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 8�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) $ _Q� ��� � <br />