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' CITY OF ORONO 'I� � <br /> BUILDING PERMIT APPLICATION � ( �� I ►'� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �i�` <br /> �O�O MailingAddress: Permitnumber: �d/�—DD�� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'j ��'( <br /> StreetAddress:' Received by: ��O.S <br /> ��, G�' 2750 Kelley Parkway Plan review fee: �Z T- �� <br /> `�kESHO�� Orono, MN 55356 �D����D��3 <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: �'�5 �?( �,,� �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Department and Crty 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 INF RMATION: <br /> Name: �c�rlc.ley ��� SC��S <br /> State License# Expiration Date: <br /> Phone: cell �� - - office <br /> Mailing Address: fj`�5}�J 6 Ic:ce (�r� Cit : ` �r�o.� ZIP: SSc/�/� <br /> Contact Person: 3,��e Applicant is: Contrac or / Homeowner (Circle One) <br /> Email andbr Fax: �5 j I,x��icl��, 3 .�i� oo ,c.o+�t <br /> PROPERTY OWNER INFORMATION: <br /> Name: Lc.�'`-e� �)��,.��r <br /> Phone (day): I�� I - K 5? <br /> Address: 5�5 OX City: a,^��o ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �tL (�rr�v��'� <br /> Phone (day): -�(7 -' �� � <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion 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. ❑ 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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ IQ,Occ"?<�"� <br /> I (. <br /> ' � . <br /> � _ . : :. �: ; <br />