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I <br /> , � la <br /> � � <br /> Cit�l of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Man�ng,addreas: p?D/Q_ O <br /> ��.j� PO Box 68 Permit number: _ <br /> Q a Q Crystsl Bay,MN 55323-0066 Date received: <br /> � StreetAddress:' Recelved by: <br /> . � 2750 Kelley P�rkway Plan review fee: <br /> 'te�� Orono�MN 55�i5B <br /> _-��� <br /> -� Toiai Fee: � C�� �8 <br /> Maln: 852-249-4800 Fax: 952-249-4616 www.ci.orono.mn.us <br /> 7his application form must be complete in full and all required information must be submitted. <br /> Incomplete applicati ns will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: zsoo shaa ood Road <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display HomeT ❑ Yes [� No <br /> K yos,e speC?a/event permlt fs requirod with Aofke Deparhr�snf en City Coundf epp�ova�60 days prbr to the event Slwtile bus servics wH!be <br /> requksd unfess epp8cant demaisbatea suAfcient on-aNs perking!s vaflable. Non-pennitted etrenfs w!N not bs a�lowed. <br /> CONTRACTOR!APPLICANT INFORMATION: <br /> Name: Watson-Forsl�er Co. <br /> State License# Expiration Date: __3/ai/aoiz <br /> P�1011B: 952-544-77 61 (OffIC@) {Cg��) <br /> Mailing Address: Cit :sc Loui$ Park ZIP: 55926 <br /> Contact Person: David Foreberg + Appficant is: ontractor / Homeowner (Clrcle One) <br /> Ef11811 a�dlo�FeX: DavidFewataon-forebera.corn; <br /> PROPERTY OWNER INFORMATION: <br /> Neme: Freahwater Society (Chrx� Prok) <br /> Phone(day): 952-314-4050 <br /> AddfASS: 25da Shadywood Road Clty: ExcelsiOr ZIP: 55331 <br /> Email and/or Fax cprok��reshwater.org <br /> ARCHITECT!ENGINEER INFORMATION: <br /> Neme: n/a <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Pro)ect 2.Proposad se 3.Structure Type 4.Sowags Dtsposal d� <br /> Water Supply <br /> ❑ New Construciion ❑Single Fa ily with ❑Residence <br /> ❑AddWon attached arage ❑Garage/Accessory Bldg. ❑Publfc Sewer <br /> ❑Accessory Building ❑ Single Fa Ily wllh ❑Decic <br /> ❑Relocation detached arage �Office/Comme►cial ❑Private Sewer <br /> �Other:(specify) remodel ❑Multiple F ily/Co�do ❑Warehouse <br /> �Public ❑Storape ❑Publtc Water <br /> "Any earth movemant may require �Commarci I ❑Other(speclfy) <br /> MCWD rev[aw d�permits. ❑ IndusVial ❑Private Well <br /> I�Mnnehaha Croek W,t�rshed Dlsbicl(MCWD) ❑C�her.(s cify) <br /> 18202 l�Nnnelonka Blvd <br /> Deephavan,MN 55381 <br /> Phone: 952-171.0690 <br /> Fa�c 982�471-0682 <br /> Estimated Construction Valuation(excluding landj 3 ss,o00 <br /> Lsst Updated: 9/29V2009 <br /> - 17- <br />