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. ' �' —� ; <br /> 1 � � <br /> CITY OF ORONO r �5-� , 7� <br /> BUILDING PERMIT APPLICATION <br /> ��/ <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: 02 D/��DO�o9 V <br /> PO Box 66 I / <br /> Crystal Bay,MN 55323-0066 Date received: 7 `Z'�Y <br /> StreetAddress:' Received by: 6.S <br /> �.F �� 2750 Kelley Parkway Plan review fee: 32Z�� �'1 <br /> �. Orono, MN 55356 �D! —�O 8 <br /> !�'�fSHv E <br /> Total Fee: t <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us G�XOV� � �� <br /> This application form must be completed in full and all required information must be submi d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: \ <br /> JobSiteAddress: S' l�; �.� ` ;Y•�J lJ\�. p�'ov�� � 1� 5-53,�'l� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No <br /> If yes,a special event permit is required with Police DepaRment 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: f1 <br /> Name: IN�a�1� a . W;l\;o,..,,.5 LvS�w� ry�ov1KS ivG. <br /> State License# (3[_ �{q yyo 3 Expiration Date: ��//(� <br /> Phone: (cell) la►�.-�S'I —q>s'c� (office) <br /> Mailing Address: •o• o Cit : �g;or ZIP: SS3 <br /> Contact Person: y�Q rk. w:11 ;cv...5 Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: yNA�k `O rv�dw� 1�:ow.S l�o�rS � �o�-+ <br /> PROPERTY OWNER INFORMATION: <br /> Name: N1:ks- Vo.�..•� o <br /> Phone(day): �o(�.- 3( v - �q S S <br /> Address: l, ? 3 3 � �b a�e 1 a+--<- City:�y��'e f�v'� ZIP: SS3�) <br /> Email and/or Fax /t�:(ce,. V a►+y o@ po�q�; S . !e n.. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (Z (J S ,4r-c 6.��-c c'�'S <br /> Phone (day): ���— �1� - �1�ot`� <br /> Address: City: ZIP: <br /> Email and/or Fax: !`d S a r� ? G vv�a.;\ . c e vv� <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <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 moveme�t 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�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) � �d V� D 0 0 <br />