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City of Orono ) P� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Z90 <br /> 0�0 PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: Mir <br /> c„ Street Address:' Received by: 7�a/ / <br /> Gk� 2750 Kelley Parkway Plan review fee: / 07(v. Fc <br /> �.� Orono,MN 55356 o�U//-00(o <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-2494616 - - <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 450 South Willow Drive, Orono, MN 55356 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes El 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: Homeowner, William (Bill ) Bowman <br /> State License# Expiration Date: <br /> Phone: 763-383-7739 (office) 952-217-7422 (cell) <br /> Mailing Address: 2230 So. Plymouth Rd #205 City: Minnetonka ZIP: 55305 <br /> Contact Person: Bill Bowman Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: hh,�wa�an@l,;i-ca-,Pwork.com / 763-559-4395 <br /> PROPERTY OWNER INFORMATION: <br /> Name: WilliEorri (Bill ) P. & Cynthia (Cindy) J. Bowman <br /> Phone(day): 763-383-7739 <br /> Address: 2230 So. Plymouth Rd #205 City: Minnetonka ZIP: 55305 <br /> Email and/or Fax bbowman@lsi-csework.com / 763-559-4395 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Homeowner, William (Bill ) Bowman <br /> Phone(day): 7 6 3-3 8 T--TTT97— <br /> Address: 2230 So. Plymouth Rd #205 City: Minnetonka ZIP: 55305 <br /> Email and/or Fax: bbowman@lsi-csaework.com / 763-559-4395 <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction Q Single Family with R]Residence <br /> EX 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 require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑Industrial [ Private Well <br /> Minnehaha Creek Watershed Dist ict(MCWD) ❑Other.(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-059D <br /> Fax: 952-471-0682 <br /> www.minrehahacreek.om <br /> Estimated Construction Valuation (excluding land) $ 200.000 <br /> Last Updated: 4/26/2011 <br /> - 19- <br />