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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address:c� Permit number: coo/V PO Box 66 <br /> r Crystal Bay. MN 55323-0066 Date received: <br /> Street Address:' Received by: /VAS <br /> tiF 2750 Kelley Parkway Plan review fee: 1 4­4c)04-1 <br /> lRktsHo Orono. MN 55356 <br /> Total Fee: / <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.crono.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: (o$s- olot C rte, s i•,t ��-, ol- �,J, Q <br /> Will this be a Parade of Homes. Remodelers Showcase Home or other Display Home? ❑ Yes ONO <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: oro-o /-1,101 c Se-4001.3 <br /> State License# 11-11 16% Expiration Date: <br /> Phone: cell office <br /> Mailing Address: OU City: /0,1 Z) ZIP: S' 3 <br /> Contact Person: J_0$ 1 c(0!1 Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: J„mac r �„Q pro Ad <br /> PROPERTY OWNER INFORMATION: <br /> Name: — 0rcv�0 bt'rr� S, Lo, <br /> Phone (day): qz- q- q <br /> Address: city: 0 ZIP: 7r 3.5-6 <br /> Email and/or Fax c co <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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/ ccessory Blda� El 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. D Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) D9 Other: (specify) <br /> 18202 Minnetonka Blvd 9ior• <br /> Deephaven. MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.rninnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br />