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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS / <br /> ��1 V Mailing Address: Permit number: O3� <br /> PO Box 66 ,/ <br /> Crystal Bay, MN 55323-0066 Date received: 3��7` <br /> Street Address:' <br /> Recivied by: <br /> 2750 Kelley Parkway Plan review fee: <br /> `qty 4 Orono, MN 55356 <br /> kESHo <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: 375'-0L,T P �c�� Nowt a 3 <br /> AN Job Site Address: ,a,,°�. rl�x��L A-,l <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICNT INFORMATION: <br /> Name: to 0'we-> <br /> State License# f3G?_V (0SG Expiration Date: 0 3 / 3/ 'S <br /> Phone: cell 7e3 Z.,Ai '-ton office `76� HZS 3353 <br /> Mailing Address: 1 wH -o i I t'-tv, ,¢vt /J Cit : - ZIP: q' ; 36 <br /> Contact Person: AtAL- IN a,/ Applicant is: ontractor / Homeowner (Circle one) <br /> Email and/or Fax: vtia,� t6? ej A-t h5 ho "A►t cc ivy (03 Oo 3`I <br /> PROPERTY OWNER INFORMATION: <br /> Name: R A J- <br /> Phone (day): -Ito -3, 5t,5- -&O o D <br /> Address: 5� O 2. 4:_'l A4 e, N City: ZIP: 6 303 <br /> Email and/or Fax �A—%5e ,nn - cc / <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): ` <br /> Address: Z`1(,� ( 3 A.� mow' City: A"dov-cr- ZIP: <br /> Email and/or Fax: <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. 5q 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 /> �U <br /> Estimated Construction Valuation (excluding land) $ ' <br />