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1 � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �C,/cu'_C r����� <br /> Q PO Box 66 Permit number: <br /> � �Q Crystal Bay, MN 55323-0066 Date received: ��—J q -lC <br /> Street Address:' Re � <br /> 2� ,� 2750 Kelley Parkw Y�C, Plan review fee: G b �' ��% <br /> r._ _ <br /> c,` Orono, MN 55356 W. _—__------------ ------ i <br /> ��'Ff5H0�� Main: 952-249-4600 Total Fee: <br /> 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2000 Shadywood Rd <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 Department and City Council approva/60 days prior to the event. Shuttle bus seivice 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: Sustainable 9 Design + Build <br /> State License# BC653457 Expiration Date: 03/31/2016 <br /> Phone: (cell) 612-636-3232 (office) 612-234-4194 <br /> Mailing Address: 124 Main St SE, STE 343 City: Minneapolis ZIP: 55414 <br /> Contact Person: Ryan Hanson Applicant is: on rac / Homeowner �c�►�ie o�e� <br /> Email and/or Fax: ryanhanson(a�sustainable9.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Sustainable 9 Holdings LLC <br /> Phone(day): 612-636-3232 <br /> Address: Same as Above City: ZIP: <br /> Email and/or Fax Same as Above <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Architect/Designer- Dave Zweber, David Charlez Designs, Structural Engineer- Nick Hanson, Hanson Group <br /> Phone(day): Dave-952.428.8200, Nick- (612) 708-3572 <br /> Address: � KilmPr I anP Nnrth SuitP#4 Pl�mnirth, MN 55441 Clty: ZIP: <br /> Email and/or Fax: dave.zweber(a�davidcharlezdesigns.com nick hansongroupmn.com <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 ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck [� Public Sewer <br /> ❑Accessory Building ❑ Single Family with []Office/Commercial <br /> ❑ Relocation detached garage C� Residence ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater [�] Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 631,720.00 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />