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• CITY OF ORONO <br /> • NOV 2 '1 2014 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS.7- <br /> O ` Mailing BoxAddress: <br /> s . Permit number: <br /> 0 Crystal Bay, MN 55323-0066 Date received: <br /> ceivec�b <br /> Street Address:' �-- - <br /> 2750 Kelley Parkway f rL ,l � Plan review fee: <br /> `� s✓ Orono,MN 55356 <br /> rgk�stto `` 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: LiLl D 40 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? Yes Pdo- <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/APPLICA T INFOR ATION: <br /> Name: C C <br /> State License# Expiration Date: <br /> Phone: cell - "00 office <br /> Mailing Address: City:--- 44,q A-k L ZIP: <br /> Contact Person: a Applicant is: ntrt / Homeowner (Circle One) <br /> Email and/or Fax: S <br /> PROPERTY OWNER INFOR ATION: <br /> Name: <<^C <br /> Phone(day): u� Ci : S ZIP: ��3 <br /> Address: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: % v UA <br /> Phone(day): <br /> Address: ndtJ City: ZIP: <br /> Email and/or Fax: c-k1O `i< til)• <br /> -7 63-0'72 -2 2 <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> New Construction 21ingle Family with esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ublic 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. El Industrial <br /> 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 /> $ <br /> Estimated Construction Valuation (excluding land) <br />