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CITY OF ORONO <br /> • <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O1V Mailing Address: Permit number: '-- i(/ -0 / 3-)'7 <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: II-26," 1 V <br /> Street Address:' Received by: o <br /> y*)1''' <br /> 2750 Kelley Parkway +`'`! ,, 1 r See Plan review fee: /v//) e /)01ej/Olt) <br /> kN. 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: //3)(3 0t-d C`R,s 1--) S Aii,ii <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? I I Yes 77 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 I APPLICANT INFORMATION�:/ <br /> Name: /..e/4-yf•2 ,/Y? � /gin' ii:! /.LC <br /> State License# b C- 3'5090(- Expiration Date: ; / 0/.5---- <br /> Phone: <br /> c/5Phone: trplll 6,i 2. 9Sz), Lio(iZ (office) 62 t z -)Z) _ `(oaZ <br /> Mailing V-- - Bi Y!� 6.c y 2c.- City: g it z?i4 - ZIP: ��S_35/ <br /> Contac ~/1-2Lcw/ Applicant is: ontraafor �/ Homeowner (Circle One) <br /> Email 2 40.1-7--"c S1V2� -r//o/i/f S . ea AI.. <br /> PROP! ` � �Ok ATION: <br /> Name: � 10 .E 7-4( <7/VW-ILC <br /> Phone cr <br /> Addre< l f\ 41-L-A,- ,,rc—/ /do City: Cov2CeA. ZIP: <br /> Email <br /> ARCH ORMATION: <br /> Name. -✓R4/rv/.Jt5--- e,f <br /> Phone (day): -,4 , 78 D •9 2 a <br /> Address: City: ZIP: <br /> Email and/or Fax: d)-1(9--,=) 6'- t fn,)) f , C'c/A-, <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 EI Single Family with Residence <br /> ❑Addition attached garage E Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building E Single Family with E Deck �,/ <br /> ❑ Relocation detached garage 0 Office/Commercial L� rrivate Sewer <br /> . <br /> O Other: (specify) a> 0 Multiple Family/Condo ❑Warehouse <br /> 0 Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial 2-P r i v a t e 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 Luz ., <br /> i www.minnehahacreek.orq `�vC_. [izu3 <br /> Estimated Construction Valuation (excluding land) y = n;'..`''- <br /> r <br /> Pc11L —O ( ( q7 <br />