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CITYOF ORONCS 5w o <br /> A <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O�r Mailing Box 66. Permit number: CA <br /> 1 YO Crystal!Bay,MN 55323-0066 Date received: 3 <br /> Street Address:' <br /> `C 2750 Kelley Parkway Plan review fee: c <br /> G Orono,MN 55356 �Sd1619 /5 3 <br /> SH04� [ <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: 37 � - P to OAteX <br /> Job Site Address: '7 oar n.��'� <br /> Will this be a Parade of Homes, emodelers Showcase Home or other Display Home? ❑Yes [X No <br /> /f 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-pennitted events will not be allowed. <br /> CONTRACTOR/APPLICT+t6L5 <br /> T INFORMATION: <br /> Name: Ho e> Pllc- <br /> S <br /> tate License# f.3e,2lioP® Expiration Date: <br /> Phone: cell 7(0Z,`11 0q office '163 `I ZS 3333 <br /> Mailing Address: k 6iw b I M AJ Ci ZIP: 5'S 3 <br /> Contact Person: tl� Applicant is: on' ctor i Homeowner (eimie one) <br /> i <br /> Email and/or Fax: Ina VK-0 wi+v1 ,cea ks3 D�39 <br /> PROPERTY OWNER INFORMATION:, <br /> Name: <br /> ' Phone(day): �15 f05 Zc'c' <br /> Address: 2 �-� ,� /u city., S-I' c t o�� zip: S'6 30 3 <br /> Email and/or Fax u �55/x. `iGt3 ® 4 v+n ca. Le <br /> ARCHITECT[ENGINEER INFORMAT ON: <br /> Name v-D i ; n �c <br /> Phone(day),. 1(o3 -7 5-7 5-10%41 <br /> A c 1 <br /> Address: - !a l *!"I, f:h A. A)kJ City ZtP: <br /> Email and/or Fax: '7(03 7 !j-7 !3 <br /> PROJECT INFORMATION: Desai tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal <br /> Water Supply <br /> New Construction �4 Single Family with Residence <br /> Addition attached garage 0 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 jPubiicWater <br /> **Any earth movement may also require ❑Commercial; ❑Other(specify) - <br /> ' MCWD review&permits. 0 Industrial [I 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.o <br /> Estimated Construction Valuation(excluding land) ' <br /> i . <br />