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• CITY OF ORONO <br /> BUILDING PERMIT APPLICATION 6.Jq q.k 9� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> • <br /> Mailing Address: Perm'it`nunb'er'' :: . / <br /> PO Box 66 ; >..:: ..:.... . ..:... �at <br /> Q' Crystal Bay,MN 55323-0066 Date received; ./41;z1 /'7 <br /> Received <br /> ; <br /> .°Y Street Address:' <br /> y <br /> • <br /> 2750 Kelley Parkway Plan'?review,fee! . ;2 700 0 <br /> Orono,MN 55356 <br /> ;t. � o17, C1 <br /> :Total Fee:. <br /> Main: 952-249-4600 = Fax: 952-2494616 www.ci.orono.mn.us ; <br /> This`application;form mustbe-.completed in',full;and:all requi`re'd,information:must`:be:.subrriitted; <br /> Incomplete applications:w'ilVbe returned: (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Ito S $ou 77f-1g 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/APPLICANT INFORMATION: <br /> Name: W 041)0011-1 LI-DEPS <br /> State License# $[ OO7-92(o Expiration Date: <br /> Phone: (c(ell) cR5Z -C28re- 3�to�} (office)¶52-545-054' <br /> Mailing Address: � , <br /> City: ZIP: <br /> Contact Person: (Y\A rr Soli 9.3 n Applicant is: 4 ontrac or . Homeowner (Circle One) <br /> Email and/or Fax: r»;o RuD &. u. DA_ -.Eu 1 Ltn--S . cop--1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: 5 kerma <br /> Phone(day): ' <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: fin% <br /> Phone(day): <br /> Address: City: ZIP: <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. RI 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 Ar 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.min neh a h a creek.orq <br /> Estimated Construction Valuation (excluding land) $ 60D,600 <br />