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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: 2-0 (4 `O( � <br /> VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Received by: <br /> SF 2750 Kelley Parkway G (C� 1� �� Plan review fee: " IL <br /> `9 <br /> Orono, MN 55356'rESHn�� Total Fee: <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: <br /> Job Site Address: 29r0 CZD Se�l / 2D. QE6v1JQ A4A,) <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/APPLICANT INFORMATION: <br /> Name: 44ca CL/ L7t'��ICti F-Su , <br /> State License# Expiration Date: <br /> Phone: cell - office (p <br /> Mailing Address: I 6 IV S4, City: ZIP: <br /> Contact Person: v Applicant is: Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: �1 <br /> Name: [�It 1 .�G t Ale L&A62, <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: AIE.k x F(z 7) fps" <br /> Phone(day): 'F' 2- 5f23 -87-7-7 —� / <br /> Address: yo/' estsr- 1.4� Sr. City:(r�AVF4,1i4 ZIP: 15Z535Z <br /> Email and/or Fax: � z _ X73 X222 <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> 6New Construction gSingle Family with J9 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.minnehahacEggL.org GfJ 1 r-, L;' <br /> Estimated Construction Valuation (excluding land) � <br /> , � f � � <br />