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, i � � � � 5 <br /> � � <br /> � � CITY OF ORONO �� �+�� � <br /> �,. � �h� �'� � � � <br /> BUILDING PERMIT APPLICATION � • p�lO�S <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> '"�� �" Mailing Address: � �— O(� <br /> � � ����, PO Box 66 Permit number: 6/ � <br /> �`�� 'i Crystal Bay, MN 55323-0066 Date received: — � <br /> + } <br /> �' � StreetAddress:' Received by: <br /> �''�;',.� �,1 2750 Kelley Parkway Plan review fee: 1li(�o . � <br /> �`�t,� ,, ��`'j` Orono, MN 55356 a�� ^D D /�� <br /> �,��Esti�?� . `Z <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: J � �� � �i�� S�'`�'�- rl v'� <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 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/APPLIC N INFORMATION: <br /> Name: ci S o�tz5 1-�� <br /> State License# aG Z�`I lu�(✓ Expiration Date: D3 31 2cis' <br /> Phone: (cell) �b-3 �q t �p`�`1 (office) 1b'3 �t 2�i �i"3 3� <br /> Mailing Address: ���y� ��1� ,�,�, h> Ciry: ��,�- �. ZIP: S C�(�� <br /> Contact Person: � ��.ti Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ,M,�,,�� ,,-�. ��tip,H;cS ,�hW . �;.p►�►1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: (�Gkc1 So,;rGZ <br /> Phone(day): _ �4�3 �';�,y �,t�c�� <br /> Address: r,0 y � N Cit : yt �1da'� ZIP: �6j�3 <br /> Email and/or Fax S�v��SD,1 1(.0�10✓ � G',r�n� � ���'VL <br /> ARCHITECT/ENGINEER INFQRMATION: <br /> Name: L r c� f �C (�c5��i+� r- �r.���*�n�� - 'S� c1�.tJr� � J'�r C.� SdJ� <br /> Phone (day): ��p-�j 1 5'1 ���7 � <br /> Address: 2q1,'� � , `I'��' N1l�t.� City: �G�pv�,�-' ZIP: � 5 3Q`� <br /> Email and/or Fax: ��- � L SDv� @ �r' � 1 X r-��5�n � �D`"'� <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) $ �5����� • D�4� <br />