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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: oT0/✓�-DOl 8 7 <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> A <br /> Street Address:' Received by: <br /> �` 2750 Kelley Parkway Plan review fee: . Y 7 <br /> �IgKESHo��G Orono,MN 55356 <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. I <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: f <br /> Job Site Address: 'zS<95y U QB(b/\y, <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/APPLI NT I FORMATIO <br /> Name: 5 rPi .�l o^�I T� 4 <br /> State License# Expiration Date: 3 <br /> Phone: cell office /Z.- $L) 0 <br /> Mailing Address: City: ZIP: 23 <br /> Contact Person: Appli qnt is: ontractor / Homeowner (circle One) <br /> Email and/or Fax: e V Glbn <br /> PROPERTY OWNER INFORMATION: <br /> Name: Ft;r Q Is <br /> Phone(day): "-460-2Jto <br /> Address: S" O City: ria ZIP: y�3 <br /> Email and/or Fax p <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> [_­1New Construction Single Family with 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) o Pn ❑Multiple Family/Condo ❑Warehouse <br /> & Lt Grl� El Public El Storage El Public Water <br /> "Any earth movement nTa 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.minn hahacr gk.or <br /> 4 <br /> Estimated Construction Valuation (excluding land) $ 25�� <br /> r <br />