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Ktc:tlVtU <br /> CITY OF ORONO JUL 2 6 2016 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS CRY OFORONO <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> � L Orono, MN 55356 <br /> !dkrsNU�� 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: S, -k <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? LJ 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 wi <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: <br /> State License# �. 'z0 L,SL,�� Expiration Date: <br /> Phone: (cell) (office) 1 <br /> Mailing Address: \1 . �z C : kl o� ZIP. d <br /> Contact Person: \��. m�-�-�Sc��'\ Applicant is: ontrac"i-or Homeowner (circle One) <br /> Email and/or Fax: - \ <br /> PROPERTY OWNER INFORMATION: <br /> Name: ACV-1�� \a <br /> Phone (day): <br /> Address: S'-AO c\ gg City: mc�,e&,C\'A ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descn tion of project: CC � e k `� ti R��,S <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4. WaterSewagisposa 8 <br /> Water Supply <br /> ❑New Construction Single Family with zff Residence <br /> F-1Additionattached garage C]Garage/Accessory Bldg. E]Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> Other:(specify) C' ❑Multiple Family/Condo ❑Warehouse Public Water <br /> ❑ Public ❑Storage ❑ <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) ❑Private Well <br /> MCWD review&permits. ❑ Industrial <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 /> U <br /> Estimated Construction Valuation (excluding land) <br />