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' CITY OF ORONO � � � �s <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: 070/�, O O�� <br /> � NO PO Box 66 <br /> Crystal Bay, MN 55323-0066 � Date received: 7—2 ' �� <br /> Street Address:� Received by: 8 <br /> � � 2750 Kelle Parkwa 2 Q�.3 <br /> yF G� Y Y Plan review fee: <br /> lqkFSHO��, Orono, MN 55356 �1� �� <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: � g� 5 �/O�T�'r �S'l�/02 F j��2/ V� <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Po/ice Department and City Counci/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/APPUCANT INFORMATION: <br /> Name: �/OM� S S'��-/�/e�Ty�/�- <br /> State License# Expiration Date: <br /> Phone: cell � (2 $!r S Z 5 3 � office S a�+ t <br /> Mailing Address: 0 5 oR1� S�!/�� p�s/ �' Cit : OR�Nb ZIP: 5 S 3 G <br /> Contact Person: )DM�.-S S'Cs�N�TL.E,�_ Applicant is: Contractor omeo ne (Circle One) <br /> Email and/or Fax: t'L,g G h G �G r G+' q .�•, �..�'/ - �ps-�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: S.k�^1�' �-S �*-P�'L/C�►-�t1T <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <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 p�C� 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) $ 6 �i ��d <br />