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CITY OF ORONO b ,d3 <br /> BUILDING PERMIT APPLICATION V �/ 5 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> icLW., <br /> o A ' ! Mailing Address: - 25 <br /> PO Box 66 Permit number: 020/ <br /> Crystal Bay, MN 55323-0066 Date received: {o'°�/ <br /> �� ���� Street Address:" Received by: p <br /> y ` /((7 �,� 2750 Kelley Parkway Plan review fee: %O�, 5/ <br /> Orono, MN 55356 ad/�-•0Ds'kESHol" 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: Z 31 U ( �v ,4 ,- <br /> _. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? n Yes El 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: �-I,(a5 `."v\'S i -1-vtc. .. <br /> State License# .(-_ 20'1 Cyd G-, e.( Expiration Date: 0 N 6 .�U 15 <br /> Phone: (cell) -,,,3 (0 11 �f Uel`' , (office) 1 73 pct 1 I 0 - 1 <br /> Mailing Address: )id I-1 5 0 l l "j h / _ Al Cit : ZIP: <br /> Contact Person: AA a,,k- W�°Y Applicant is: contractor / Homeowner (Circle One) <br /> Email and/or Fax: lima.,L C ' ti�s ildivt.e.,3 w1,& - Cc) <br /> PROPERTY OWNER INFORMATION: <br /> � � 1� <br /> Pame: ' <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINER INFORMATION: <br /> Name: c L-i A� _ D(,1. 1')h.) <br /> Phone (day): �;07 - 3q) '-' 3 ?S <br /> Address: k Of- <br /> City: OSS cb ZIP: S 7 6 c1 <br /> Email and/or Fax: <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 FKI 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) ., ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial caPrivate 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) $ CI Z I - °c <br />