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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> r <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> �0A, Mailing Address: <br /> 'YO PO Box 66 Permit number: aO� S— L <br /> Crystal Bay, MN 55323-0066 Date received: 1 / <br /> Street Address:� 'ved • �� <br /> 'y�, G, 2750 Kelley Parkway �' �$ Plan review fee: �t <br /> �`�KEstto��" Orono, MN 55356 �� � ' � � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application forrn must be completed in full and all required informa#ion must be submitted. <br /> incomplete applications will be�eturned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� p�n4�S�.� � �1�dh �'�1`N. � '3 <br /> Will this be a Parade of Homes, Remotfelers Showcase Home or o her Display ome? Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approyal 60 days prior to the event Shuttle bus service will be <br /> required unless 8pplicant demonstrates sufl5cient on-site parking is available. Nony�ermitted events will not be allowed. <br /> CONTRACTOR/AP��ICAN INFORMATION: <br /> Name: (,� ��, <br /> State License# �1 � Expiration Date: � <br /> Phone: cell -;�� - � office - 4�-6�0 <br /> Mailing Address " 7 �at rNQ Ci : �1,c� ZIP: � � <br /> Contact Person: ,� Applicant is: Cantractor / Homeowner (Circle One) <br /> Email and/or Fax: �, r„�- a � <br /> PROPERTY OWNER INFORMA ION: <br /> Name: �� p� �. <br /> Phone (day): _ - � <br /> Address � �. Ci : �o�C � ZIP: Cj� �1 <br /> Email and/or Fax •�� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Ci#y: ZIP- <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Stru�ture Type 4.Sewage Disposal 8� <br /> ❑New Construction �f Single Family with Residence Water Supply <br /> �Addition attached garage �Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑ Office/Commercial <br /> ❑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) $ <br />