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CITY OF ORONO )5 31g <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O�r Mailing Address: Permit number: <br /> VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 6-02-/ <br /> Street Address:' R29.e ved by: <br /> y� C� 2750 Kelley Parkway Plan review fee: 5`��- 9 <br /> tgkFsrlo Orono, MN 55356 � $3ze v <br /> Total Fee: ��� �. <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.m _pp �S <br /> This application form must be completed in full and all required information must be submitt 1 1 ,p l <br /> Incomplete applications will be returned. (Please print) ` 5 <br /> GENERAL INFORMATION: LST' 2 18�,� l /Jc�2 *04 <br /> Job Site Address: �! D �o��u �r✓L ;` S <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 wil 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: A +- I H s �-(0•ht s <br /> State License# 13 C_ 2(, ej &®n r, Expiration Date: 03 / 3/ / 15- <br /> Phone: (cell) --1 (0 3 ij,ti l -1 o ci li (office) 7I-3 H 7-,5- 3 3 3 3 <br /> Mailing Address: I H x-15 o i 1 -7 in A vu N City: D-,XJ4v,_ ZIP: S 5 3,6 `1 <br /> Contact Person: Ma,L W,,,/ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: _yt Kv 1✓ G ri}Inr5 ko&v-.> w,vL <br /> PROPERTY OWNER INFORMATION- <br /> Name: gle.=1s5v <br /> Phone (day): -7(0 3 S 10 5- 2 0 co v <br /> Address: -p Z +_u. All city: 5) L (c..=a ZIP: <br /> Email and/or Fax �,kVV;Sv.1 L.o kv- ( - g��N,' cM <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): 7_a L!A 13 ` <br /> Address: leo 3 -7 S '7 Sri`1"] City: ZIP: <br /> Email and/or Fax: h 3 -? 9 7 " 3S .3 <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. 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 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 /> $ <br /> Estimated Construction Valuation (excluding land) , 7--St d o <br />