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9 <br /> • • CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O `j` Mailing Address: Permit number: 00/(1 O�/° <br /> T PO Box 66 <br /> LI <br /> Crystal Bay, MN 55323-0066 Date received: f0'�L' <br /> Street Address:' Received by: <br /> y ," 2750 Kelley Parkway Plan review fee: 4�' T 3.1 <br /> `�r,' ��G, Orono,MN 55356 p90/� D9 <br /> kEsrt° Total Fee: T J <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us mow { <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: 23 Zit S.haiquo coo( Rd ©r-avad, MN <br /> Will this be a Parade of Homes, Remodelers Sh&fcase Home or other Display Home? ❑ Yes .4j 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: Vascph 4 Laura McCtti—ky <br /> State License# Expiration Date: <br /> Phone: (cell) SD '7- 2.S 1- 3(a /O (office) SO 7—251 --3(0 )o <br /> Mailing Address: 3 Z Shad o o t? , Cit : Ore,-)o ': SS 3' <br /> Contact Person: LQ.Lt.rvl NIC Cit t Applicant is: Contractor / Homeown- (circle one) <br /> Email and/or Fax: L Nil C C. LL 2 Dy 2.&GA to / i.- ,C..rrYl <br /> PROPERTY OWNER INFORMATION: <br /> Name: -Tose p k, 4 1_a ,troi MC CLlr'k1 <br /> Phone(day): 5o 7- 25 1- 3(o l o (La t v ) <br /> Address: 2-3 ZH S h..ad lnfao d )2_61 City: Q r 0✓-)O ZIP: SS 39 I <br /> Email and/or Fax l_M .0 <br /> C G{ 2.Dy 2 G/v1,4 1 L ,C,tr/1/1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: JDSepH- 4 Lac.ra MCaur71 - - ft YrCd vsrtCVS <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> — <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction isj Single Family with 0 Residence <br /> j 2Addition attached garage '$j Garage/Accessory Bldg. Is Public Sewer <br /> ❑Accessory Building 0 Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo ❑Warehouse <br /> 0 Public ❑Storage n Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. 0 Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) $ £0' eo l7 <br />