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. � <br /> < • <br /> CITY OF ORONO �� <br /> BUILDING PERMIT APPLICATION � �� <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � <br /> �O� Mailing Address: Permit number: o?�� —D�,S.� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0 Date received: ✓��8/ <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway �I� I� Plan review fee: � �J - �� <br /> `� ��� Orono, MN 55356 � p�0/ aQSr <br /> `qKfSH� 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: J a 6 S �erN�.w�� 1Z1 �J i l,�G-�Z�.�� � M N <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe D sir play Home? ❑ 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: f�v;s,a,,, ��-L <br /> State License# (3� C`Z�i�-L� Expiration Date: o s�,c <br /> Phone: (cell) �,SZ- $�lo -�1�Sc� (office) qSZ- ba7- S59'� <br /> Mailing Address: i S3 E L lc1_ s City: (,,��,u�..��, ZIP: SS3`S � <br /> Contact Person: a ��l Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: Jolnn n �v_u� .�5� _�,,. - c��, .J0�1Y� � r�ViSl01f�YYll1.C1?!W1 <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �vC�s � L i�., f�c� <br /> Phone (day): S/� —3.� — 27f1/ <br /> Address: 5 A,r-•-c. Cit : ZIP: <br /> Email and/or Fax 1 j' � ,�Q,C•�(� <br /> I ARCHITECT/ENGINEER INFORMATION: <br /> I Name: <br /> ��Phone (day): <br /> Address: Ciry: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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) ❑Other: (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) $ Z S�,v�J <br />