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CITY OF ORONO <br /> • <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS • <br /> %'�' Mailing Address: (1 <br /> (�p, Permit number: �J�, ( G U <br /> `yO PO Box 66 t•-IC <br /> / Crystal Bay, MN 55323-0066 Date received: l 151 <br /> Street Address:' <br /> Received • <br /> y 2750 Kelley Parkwa rj tP 7_2 -78- <br /> Nr <br /> \?,,, �t Orono, MN 55356 �n� O0(D71ez-z--' a <br /> �.kfstto Q Q+ � • 9 <br /> Toniree: A` 28 t <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) Lrvw.9 S'-S-iS <br /> GENERAL INFORMATION: <br /> Job Site Address: ("ACM 4• DID Crysk.-1 Ig6.7 6l <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dis lay Home? ❑ Yes IA] 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 LLVFORMATIO , <br /> Name: c.,...-- .e1 4,\cj <br /> State License# Expiration Date: <br /> Phone: (cell) (01Z-114- Sip; (office) 74,3-q#72-lobo <br /> Mailing Address: 75-t 7 elt 5-1,-4 4 r %i e City: If...v� ZIP: 533 z..t. <br /> Contact Person: '--ij.^`... .,.-‘ob Applicant is: ntrac o / Homeowner (circle One) <br /> Email and/or Fax: b,-,1/4 a,.� 2_ .,c-' di, . c..c v.% <br /> PROPERTY OWNER I ORMATION: <br /> Name: :ti Corr..., o e•e✓�%� LLC <br /> Phone (day): _552.- X73 -,Sbe <br /> Address: '1Zo <br /> 7:„ <br /> Address: ( 5e..)-1., City: 1.1‘.42e., . ZIP: S3"3q) <br /> Email and/or Fax gr,dlree- • 4-9$ciA.1 P .St►+i, 4-ee.1.r.;c..1 • cd v� <br /> ARCHITECT/ENGINED INFORMATION: ���� <br /> Name: d,%\ 1 .,., <br /> Phone(day): 1103- 5c7 - �g 1 <br /> Address: 15'6511 ;tot' o. A A 0 c, City: ..?\.4.0,.o.,}4.„ ZIP: .S,s-yt.) <br /> Email and/or Fax: '"f ttvve.ie... e pc..,1 Lta,../.c.ia.-c 1.; , cc.uut <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/Accessory Bldg. g Public Sewer <br /> AI Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocationdetached garage ig Office/Commercial , ❑ Private Sewer <br /> Other: (specify) F•,.v► .e <br /> ee., •••► ❑ Multiple Family/CondoIE Warehouse <br /> ❑ Public ❑ Storage g Public Water <br /> **Any earth movement may also require jaCommercial ❑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.orq <br /> Estimated Construction Valuation (excluding land) $ 21 D)o,Do u <br />