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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A�O Mailing Address: Permit number: <br /> {Y PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ro- -t <br /> Street Address:' Received by: <br /> 2750 KelleyParkway L` Y Plan review fee: 5 7• 53 <br /> t Orono,MN 55356 <br /> kEsx°�``` Total Fee: ca?al3-•dDJrDJ <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: ® 99¢1e,14- 09Z> <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes NW01 <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 FORMATION: <br /> Name: id e/ <br /> State License# - —o Expiration Date: <br /> Phone: cell - office Z-6 C� <br /> Mailing Address: ZS14> ox-O Ci Z 3 <br /> sv- <br /> Contact Person: `� U 5g!'r Applicant is: Contr ctor / meowne (circie one) <br /> Email and/or Fax: 7--29/SOrIe 4 0d <br /> PROPERTY OWNER INF�iyIATION: <br /> Name: <br /> Phone(day): 95-Z - 0-®e( <br /> Address: 7Z-/o (:�ke-ev a 4Ti� 9- City:/A/" ZIP: <br /> Email and/or Fax -T— --a,'- .4.4- �b., _ <br /> T <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): A P <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descrition ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal tip <br /> Water Supply <br /> MJVew Construction 25Single Family with ElResidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with deck <br /> ❑Relocationdetached garage El Office/Commercial ElPrivate Sewer <br /> :Other: (specify) 2��Lt 0AWT El Multiple Family/Condo [:1 Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "'Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑Industrial L!PPrivate 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.minn hahacr ek. r <br /> Estimated Construction Valuation(excluding land) $ 12,V706 <br />