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CITY OF ORONO <br /> BUILDINGP RMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> MQaiiing Address: Permit number: © 01 L/ <br /> O PO Box 66 <br /> Crystal Bay,MN 6=3-00W Date received: <br /> Street Address:' <br /> Reci6ived by: <br /> ti 2750Kelley Parkway Plan review flee <br /> t Orono:,MN 55356slio <br /> Total Fee. i <br /> Main: 952-2494600 Fax: 852-24 1'6 wwwu, i.orono.mnaus jj/c/-p , ' - <br /> This application form must be completed in full and all required information 11 ps be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: LST' �wec�c. I <br /> Job Site Address: <br /> - -s <br /> Will tills be s Parade of Homes, RemodelersShowcase Mome:or other Display Home? EIVes No; <br /> If yes,a spede/event permit is r"Wred with Police Department and City Council approval 60 days prlar to the event ShutHe bus service till be <br /> required unless applicant demonstrates sufficlent 6n-site parking is a vailable. Non-permitted events Wfil not be allowed. . <br /> CONTRACTOR/APPLICANT INIFORMATION <br /> Name; 1 opt-e-3 u C <br /> Stat6 License,# ( t 2 6 I &®��, Expiration Date: 6 3 31 `/ J <br /> Phone: cell iia 9It, -i1- t!Z 3 3 <br /> Mal1JngAddress: l qH o 111+-!3 City: 1>. K_ zip S5 _"67i <br /> Contact Person:, Applicant w Contra or / Homeowner (cimte one) ;f <br /> Em M1 and/or Fax: vw4v k- G a lam '6 <br /> ntj ftA .G® <br /> PROPERTY OWN �. <br /> ESR INFORIl11A�11,ON� <br /> Man ir: <br /> Phone(day): •ks 3 S �' Z-0 C9 z> <br /> Address: _ � AT, City: 5`C(o ZIP: 5 6 7503 <br /> €mail!and/or FaX -s s°A. ILO ilasr C@, Alk <br /> ARCHITECT/ENGINEER INFORMATION" <br /> Name: C.rth�fC A <br /> Phone(day): !t1 <br /> Address, 7�0�'�, -7 T 7 5-41-7 City: <br /> Email and/or Fax: :1 , -757 0 35�3 <br /> P R QJ IE C T IINFORMAT19,N; Pescriplon of project <br /> 1.Type of Project 2.Proposed tse 3.Structure Type 4 Sewage'Disposal 8 <br /> Water Supply <br /> New Construction Single Family with Residencx= <br /> Addition attached garage Garage/,4ccessory Bldg. ' Public Sewer <br /> ❑Accessory Building 10, Sing[ Family w ith B,Dock <br /> ❑ Relocation detached garage OfFuce/Com Nmercial Private Sewer <br /> ❑Other: (specify) Uu,Itiple Family F Condo ]Warehouse <br /> Publ c [3 Storage i?r�blic Water <br /> **Any earth movement may,also require E]Comrr�rcial 'OOther(5pedffy) <br /> MCWD review 8 pectnits. �industrial — fl Private Well . <br /> :Min,0 ehaha Creek Watershed District(MCWD) ]Other:(speafy) -` <br /> 18202 Hhh6ton'ka"Blvd <br /> Deephaven;MN 55391 <br /> r, <br /> 1,Phonw, 952-471-0,590 <br /> - <br /> _ . ) <br /> Fax: 92-O1.M82 <br /> www.minnehahawreek.oM," <br /> Estimated;Construction Valuation (excluding land) <br /> r <br />