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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION NOV 2 1 2014 <br /> FOR NEW STRUCTURES OR ADDITIONS No <br /> Mailing Address: Permit number: a(� ,0 <br /> PO Box 66 <br /> / Crystal Bay, MN 55323-0066 Date received: 1 ( 1;_1 I 14 <br /> Street Address:' ...-- Received by: PiAm <br /> ti 2750 Kelley Parkwayf� (�iL. �( c Plan review fee: ' <br /> FSFro� Orono, MN 55356 <br /> k <br /> Total Fee: �� �, i/j 3 7 <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: 0 t,� Z4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? ❑ Yes <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/APPLICAt4T INFOR4ATION. <br /> Name: fc5 Vc C <br /> State License# Expiration Date: <br /> Phone: cell "o© office <br /> Mailing Address: l� Cit ZIP: <br /> Contact Person: o Applicant is: ntract / Homeowner (circle one) <br /> Email and/or Fax: ,J S01 4 <br /> PROPERTY OWNER INFOR ATION: 1 <br /> Name: t- 4 ,�.-• C <br /> Phone (day): "p© O , <br /> Address: �� Cit [S ZIP: 5� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: r , v <br /> Phone (day): — 71r <br /> Address: Cit ZIP: <br /> Email and/or Fax: L p K ,--,D, <br /> a3—0172— X2-2/ <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 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. ❑ 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 /> $ �o <br /> Estimated Construction Valuation (excluding land) 1 -7 S-, ©6t <br />