Laserfiche WebLink
CITY OF ORONO 24( 3 <br /> `� APPLICATION' • <br /> ?�� <br /> v�\ BUILDING PERMIT / � a �� <br /> FOR NEW STRUCTURES OR ADDITIONS ,. <br /> �O • Mailing Address: Permit number: a04a04-3� - 0/301 I <br /> �j PO Box 66 <br /> Crystal Bay, MN 55323-0066 ' Date received: /,P -36-/3 <br /> Street Address:' Received by: 666 . <br /> yF 2750 Kelley Parkway Plan review fee: d0I 3-613 20 <br /> �' Orono, MN 55356 2.�0 <br /> l�kFSH°� Total Fee: �3 <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: _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 7 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/APPLICANT INFORMATION: <br /> Name: rel w,-7-f x-e kr f-,--:› G045 <br /> State License# Z r r, - Expiration Date: C33/, //-/ <br /> Phone: (cell) -76 j " a-21f-/6-00 (office) "7-T3, 20-7 - it76. <br /> Mailing Address: 5 ' , -e,,,,uc. ok,r-1- Al Cit : Av_ter �,,,c ZIP: 5,5 '3 42 <br /> Contact Person: - 6:77 Applicant is: - •ntract•r Homeowner (Circle One) <br /> Email and/or Fax: 3'o,sh ,. ,A---K-It-,e--,-11 P/usc, ( -r 1 ~761 76• - # 4Jo2i✓ <br /> PROPERTY OWNER INFORMATION: <br /> Name: c_c.(-flyV t I s'CI <br /> Phone (day): (:f2 9 9v- -6-- 5'7 <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Fzc.M - /7/5-e/ci-z/7 <br /> 1. Type of Project 2. Proposed Use �/ 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> E New Construction [' Single Family with .❑Tesidence <br /> ,2rAddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> E Accessory Building ❑ Single Family with ❑ Deck <br /> E Relocationdetached garage ❑ Office/Commercial ❑ Private Sewer <br /> CIOther: (specify) k,2_1(_. ‘,vi--. El Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage [' Public Water <br /> ""Any earth movement may 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.minnehahacreek.orq <br /> $ <br /> Estimated Construction Valuation (excluding land) � 61 <br />