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���..._ .�_� ..w..�...b.. � __ �_ . _.__.. �..__ _ .,_ <br /> - -- — _........�-- �- ,�.:....n.�es.��d.,�.rv:.. - <br /> - C <br /> , � �� � <br /> ! CITY OF C�RONO � ��2 ��.� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS " <br /> t �F <br /> � Q p. Mailing Addresss �� <br /> � r�`vO PO Box 66 Permit number:q�/ �fl <br /> Crystal Bay,MN 55323-0066 Date received: /— oZ 7—/ ' �4 <br /> a Street Address' Received by: � �,j <br /> y� �.'� 2750 Kelley Parkway Plan review fee: � //$. �9' ' <br /> `�9kFSH��� Orono,MN 55356 4' <br /> � Total Fee: ��� � �� �� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn us �� <br /> This appiication 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: ����' �Z 1 �,.��� �,,L`� � ��r-� �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No u <br /> /f yes,a specla(event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shuftle bus service w///be <br /> required unless appticant demonstrates su�cient on-site parMng 7s avaitable, Non-permitted events wiN not be allowed. <br /> CONTRACTOR!AP ICANT INFO MATION: " <br /> Name: G � � ��� ; <br /> State License# �:., c' Expiration Date: -, � <br /> Phone: cell I - . 2�L�=— <br /> - office <br /> Mailing Address: } Cit : , Z�p_ �'� <br /> Contact Person: -� � <br /> Applicant is: Contract r / Homeowner (Clrcle One) �' <br /> Email and/or Fax: € <br /> � <br /> PROPERTY OWNER INFORMATION: � � <br /> Name: '��Q � � �.�,t �Il z <br /> Phone{day): �� ��j _, c- t� � <br /> Address: c c~- 6 6-u�� �,�c Cit :�q-�47 ZIP: � <br /> Email and/or Fax �i . ` � � . � <br /> ARCHITECT/ENGINEER I�OR TION: r '" <br /> Name: I <br /> � ICt,� r2a mr� � � C'�v`1 � <br /> Phone(day): • � � <br /> �LU� ' n :� � . <br /> Address: � �'��- �[, City'�Ct�,n,,,� ZIP����-`�-� <br /> Email and/or Fax: �,��w'��p �t <br /> PROJECT INFORMATION: Descri tion of ro'ect• �' <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Su I ��' <br /> �New Construction PP Y ; <br /> ❑Single Family with ❑Residence <br /> Addition attached ara e <br /> ❑Accessory Building g 9 ❑Garage/Accessory Bldg, `�Public Sewer <br /> ❑Relocation 0 Single Family with ❑Deck <br /> detached garage ❑Office/Commercial <br /> ❑Other:(s peci f y) ❑M u l t i p l e F a m i l y/C o n d o ❑W a r e house ❑Private Sewer <br /> ❑Public ❑Storage �Public Water <br /> **Any earth movement may also requlre ❑Commercial ❑Other(specify) <br /> MCWD revlew&permits. ❑Industrial ❑Private Well <br /> Minnehaha Creek Watershed D(strict MCWD <br /> 18202 Minnetonka Blvd � � �Other:(specify y <br /> Deephaven,MN 55391 S��Q'�` ��U1�f <br /> Phone: 952-471-0590 J� , J� � <br /> Fax: 952-471-0882 LLA/I <br /> .minnehaha eek.or �'�' <br /> Estimated Construction Valuation(excluding land) $ � <br /> L�./ �� �� <br />