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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: <br /> PO Box 66 Permit number: al S-002-1 <br /> Cf <br /> Crystal Bay,MN 55323-0066 Date received: <br /> 1-0 <br /> Street Address:' Received by: <br /> y �0k 2750 Kelley Parkway Plan review fee: p <br /> �G Orono,MN 55356 <br /> 1kfSH0A Total Fee: rlY'�� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Otte(Ibt, <br /> This application form must be completed in full and all required information must be submitted. � l4/I� <br /> Incomplete applications will be returned. (Please print) err 7-1GENERAL INFORMATION 1-1b <br /> Job Site Address: 3 Wayzata Blvd,Orono, MN 55356 <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: Municipal Builders,Inc. <br /> State License# N/A Expiration Date: N/A <br /> Phone: (cell) 612-232-7876 (office) 763-421-8790 <br /> Mailing Address: 17125 Roanoke St.NW City: Andover ZIP: 55304 <br /> Contact Person: Nathan Neubauer Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: natePlmbi.com 763-421-1028 <br /> PROPERTY OWNER INFORMATION: <br /> Name: City of Orono C4 n0 <br /> Phone(day): 952-249-4661 <br /> Address: 2750 Kelley Parkway City: Orono ZIP: 55356 <br /> Email and/or Fax 952-249-4616 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Bolton&Menk <br /> Phone(day): 952-R90-n569 <br /> Address: 12224 Nicollet Ave City: Burnsville ZIP: 55337 <br /> Email and/or Fax: sethpe@bolton-menk.com <br /> PROJECT INFORMATION: Description of protect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction Water Supply <br /> ❑ ❑Single Family with ❑ Residence <br /> El 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) Re-roofing El Multiple Family/Condo 0 Warehouse <br /> ® Public ❑ Storage ® Public Water <br /> "'Any earth movement may also require ❑Commercial ®Other(specify) <br /> MCWD review&permits. ❑ Industrial Wellhouse 0 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.mi nnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 12000 <br />