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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O�T Mailing Address: Permit number: C12 j 3r18210 <br /> 1 VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /5 <br /> Street Address:' Received by: <br /> y 2750 Kelley Parkway Plan review fee: <br /> ESHO Orono, MN 55356 <br /> 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: 5Z 6 ®� � � � Raj d�®�D <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: 44ELl-y <br /> State License# $C; 1565, Expiration Date: <br /> Phone: cell ' — office <br /> Mailing Address: ( Cit : -IP: <br /> Contact Person: y=FZ1_J__y 36kM Q Applicant is: Contractor / Homeowner (Circle on ) <br /> Email and/or Fax: W�t�� r��N 2 C2, PrNe_ t-, a r©tn <br /> PROPERTY OWNER INFORMATION: <br /> Name: 6 t�_-glp—%-? c- 0tAa u�L -5�x)CJ <br /> Phone(day): _ 4.4 <br /> Address: �ptQ City: ,� �� ZIP: <br /> Email and/or Fax <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 ❑ R idence <br /> ❑Addition attached garage ❑ arage/Accessory Bldg. El Public Sewer <br /> El Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) PCUt2E �X)6, ❑ 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 /> Estimated Construction Valuation (excluding land) $ <br /> O. Y. " I s swt - r oov ro l P A+sjo ON&V g •2 IN Z&13 <br />