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. <br /> � CITY OF ORONO � �(P �-� <br /> ,�, �, � <br /> BUILDING PERMIT APPLICATION <br /> C �FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: <br /> �Or VO ��� PO Box 66 . �� Permit number. �jG��J -��<,l� <br /> � Crystal Bay, MN 55323-0066 � � Date received: - G/� <br /> StreetAddress:' �� , Received by: � <br /> ti�, G� 2750 K ell e y P a r k w a y v(��� P l a n r e v i e w f e e: � �/. �'�J <br /> lqkfSHO�� O r o n o, M N 5 5 3 5 6 ��� 3_�5-C�n <br /> Total Fee: ���� ,,,,..�� <br /> Tt� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �=�xWv �Q,C�a '�'L'�.j <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: 3(0� (�� .�ryy� �,nQ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dispiay Home? ❑ Yes � No <br /> If yes,a specia/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/APPLICANT NFORMATION: <br /> Name: <br /> State License# ���?30� Expiration Date: 3 � <br /> Phone: cell 2.- O- 30 office `j'S2-Q�o1}-72 <br /> Mailing Address: Cit • ZIP: �3 <br /> Contact Person: Applicant is� Contra tor / Homeowner (Circle One) <br /> Email and/or Fax: � �, <br /> PROPERTY OWNER INFORM TION: 1���� �i Z �S 'Z�(Q1 <br /> Name: $�0.h �¢y� <br /> Phone (day): (p I�- 38a _ �-{4$5 <br /> Address: �3(flp �,•}�,s �.�y� � City:DYnIY7 ZIP: �53(,4 <br /> Emailand/orFax ���,,��y����d\(,�y�qy�Q�l.Q��, �h;, <br /> ARCHITECT/ ENGINEER INFORMATION: 1. <br /> N a m e: �/1�lr�lul� '�P..'s�qh �{Ud4,r <br /> Phone (day): q�2- 25"D-1�41 <br /> Address: Z S' Cit : a ZIP: <br /> Email and/or Fax: M,�(� p,y� ,�,�����s.(av� <br /> PROJECT INFORMATION: Description of project: <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 ❑ 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 /> Estimated Construction Valuation (excluding land) $ (�O� ��O� <br />