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Jul 13 14 02: 47a Nate Barke 507-345-5817 p. 2 <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATlON <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O� Marlrng Address' -(`�Q(�; 3 . <br /> PO Box 66 Permit number: <br /> � Crystal Bay, MN 55323-0066 Date received: 5� <br /> 1 <br /> � 5treetAddress:' Received by: <br /> �y� � �;1 2750 Kelley Parkway � Plan review fee: <br /> � ' Orono, MN 55356 I <br /> l�Kksr�o��" `� ��7 �( <br /> Total Fee: <br /> Main: 952-249-460Q Fax: 952-249-4616 avww.ci.orono.mn.us <br /> This application form must be completed in full and all required information must b itted. ' <br /> {ncomplete applications will be returned. {Please print) � � Q �.� • ��;��_ <br /> GENERAL INFORMATION: <br /> Job 5ite Address: '����'J � UY�'1n �`rLcSv2� �Y <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? —� <br /> !f yes,a specia!event permit is required with Police Department and City Counci!approva160 days prror to the evenL Shuttle bus service wd!be <br /> requi�d unless applicant demonstrates sutficient on-srte parking is avai7able. Non-permitted events will not be aUowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: � �C. �<�G-Y_V��" yS�'GW�S <br /> State �icense# 1 3311 Expiration Date: 3� �_ <br /> Phone: (cell) (afFce D?'��?�OSDp <br /> Mailing Address: u � VL y Cit : ____ZEP: _ (p p c� <br /> Contact Person: �vt � Yt�i {�- Applicant is: ontractor / Momeowner (CircleOne) <br /> Email andlor Fax; �,J�j vt�{-U�k�� hn��;�v��v l,e.�t_�oa.S�WLeivi�• CCSYv� pr so?� (925�33�-I 3 <br /> PROPERTY OWNER INFOR ATION: <br /> Name: � ti� a,�/ <br /> Phone (day): �p�2. -�l l,F � 1 53 , ( <br /> Address: �il"15 Nov� 11aYt �0� City: (�vby1 U ZIP: S�3 LP`�T <br /> Email andlor Fax <br /> ARCHITECT i ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/ar Fax: <br /> PROJECT INFORMATION: Descri tion oi ro'ect: <br /> 1,Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ❑ New Construction ; ❑ Single Family with (�.Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Sidg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached yarage ❑ OfficelCommercial ❑ Private Sewer <br /> �] Other:(specify) �X�,YI�' �� ❑ Multiple Family/Condo ❑Warehouse <br /> SYSf� ❑ 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:(5pedfy) <br /> i <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 553�1 � <br /> Phone: 9521i71-0590 <br /> Fax; 952-471-0682 <br /> www.minnei�ahacreek,or <br /> Estimated Construction Valuation (excluding land) $ Z� "�JD • b� <br />