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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> qT Mailing Address: Permit number: <br /> YO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: <br /> Received by: <br /> s 2750 Kelley Parkway Plan review fee: lel/- <br /> Ft Orono, MN 55356 O <br /> �krs ttO _ ____ <br /> �_.._.. Totaf-Fee:- <br /> Main: 952-249-4600 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. (Please print) Gzkls-7 l Z — <br /> GENERAL INFORMATION: <br /> Job Site Address: 2605 Wayzata Blvd <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes x❑ No <br /> If yes,a special event permit is required with Police Department 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: <br /> Name: Owner <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Steven Fichtel Applicant is: Contractor / Ho owner (Circle One) <br /> Email and/or Fax: See below <br /> PROPERTY OWNER INFORMATION: <br /> Name: WJM Properties, LLC (Morrie Wagener) <br /> Phone(day): 952-543-7896 <br /> Address: 2605 Wayzata Blvd City: Orono ZIP: <br /> Email and/or Fax morrie.wagener@morries.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Steven Fichtel Architects <br /> Phone(day): 612-670-2900 <br /> Address: 435 Idaho Ave North City: Golden Valley ZIP: 55427 <br /> Email and/or Fax: stfarch@aol.com <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <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 movement may also require ® Commercial ❑ Other(specify) <br /> MCWD review&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 />