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. _ � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: <br /> �O� PO Box 66 Permit number: Q –Q <br /> � Crystal Bay, MN 55323-0066 Date received: /� //–/ <br /> � �� <br /> StreetAddress:' Received by: <br /> ��. G1�� 2750 Kelley Parkway 7 lan reviewfee: �Q/ �– / <br /> t SH Orono, MN 55356 � ��Z �.7,8, <br /> �,���°�.�. � 9 <br /> oa <br /> Main: 952-249�600 Fax: 952-249-4616 www.ci.orono.mn.us � � . '�S' <br /> This application farm must be completed in full and all reguired inf�rmation must be submitted. <br /> lncomplete applications wiii be retumed. (Please print) <br /> GENERAL INFORMATION: <'i' `'' <br /> Job Site Address: � , � � � <br /> Will this be a Parade of Homes, Remodelers Showcas ome or o er D� lay Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City ouncil approval 60 day prior to the event. Shuttle bus service will6e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP CANTINFORMATI N: / <br /> Name: ,�� � , [ �, a�,� <br /> State License# �xpiration Date: �3 � - <br /> Phone: cell _ _- p � office fl � �� <br /> Mailing Address: '- / Cit : � ZIP: <br /> Contact Person: � Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � % � % ,� <br /> PROPERTY OWNER I R ION: ; � � 31�0 1 <br /> Name: <br /> Phone(day): _ �¢r t� �I <br /> Address: <�,� 5?��,�-�,�4,-, ,�� Citv: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEE INFORMA ON: <br /> Name: f-� f ...�. <br /> Phone (day): ��-- — �p <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> in le Family with �esidence <br /> .�.Addition attached garage ❑Garage/Accessory Bldg. �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial <br /> ❑Other: (specify) ❑Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> *"Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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) $ �. �Q. p(lj c� --�� <br />