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� � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �U � �`���� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � <br /> StreetAddress:' R �eived�y:.___-- <br /> y � 2750 Kelle Parkwa t-,�� ' I� �-�, <br /> �. � Y Y C ,— L Plan review fee: <br /> lqKESH���G Orono, MN 55356 `�'�� c� G�'� ' <br /> Total Fee: ,�c✓� P�Y��t <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us — �t � �( :�. <br /> This application form must be completed in full and all required information must e submitted.,�� 1 � �I � <br /> y�g Incomplete applications will be returned. (Please print) �,rs� q�2��S <br /> GENERAL INFORM 10 : <br /> Job Site Address:� o!'� 1"�r� �'�, L��' 2 2. i�/rc-/S � lc�-k'e,�� �e,t�,✓, <br /> Will this be a Parade o omes, Remodelers Showcase Home or 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. Sh ttle us service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> P <br /> CONTRACTOR/APPLIGANT INFfJRMATION: `. � <br /> Name: �,�i n� 5 /1�ur G-� .f��'- �-�,.�� ��� ����'C,�• <br /> State License# 3 - �,��y Expiration Date: 3 3 i� i'7 <br /> Phone: (cell) 6 i z 3�'G 7G G/ (office) 7i 3 s�%"Zc/9� <br /> Mailing Address: % ,�iS �5` - ve �. Cit : / u1�r-�+� ZIP: S'�i's'L <br /> Contact Person: C�riS Nvf'��or.. Applicant is: Contractor / Homeowner� (CircleOne) <br /> Email and/or Fax: C�r�S rt1 ,;� nv-���K N�ar�5. ���� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��i r� s r7���'�� _._ <br /> Phone (day): 6�1- 3z�G - 7�G � <br /> Address: City: ZIP: <br /> Email and/or Fax l � <br /> ARCHITECT/ ENGINEER INFORMATION: I/ � <br /> Name: TJr�� r l�nn� �� �= i�zs.�.l �r,;�—_�� . <br /> Phone (day): 7 G 3 - '7�c� �Zcv H <br /> Address: f� +3�.. ,'r•�vr 3f- I'✓c City: �j j�,,.� ti � ZIP: 7�y� y <br /> Email and/or Fax: �; � ; , ��i�V1 <br /> � <br /> PROJECT INFORMATION: Description of project: ��.�✓ o - <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 �rivate 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) ❑ Othef: (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) $ ��� QO n <br /> � <br />