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I I X5 (0,-75 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mating Address. Permit number: <br /> Og..O.�O PO Box 66 <br /> Crystal Bay,MN 553234)066 Date received: <br /> a Street Address.' Received by: 7�0?/ <br /> jai <br /> 20le Park y Pian review fee: <br /> Orono, <br /> Total Fee: <br /> Mair: 952-249-4600 Fax: 952-249-4616 mvw.d.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <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 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 onsite 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: hhnwrnan@i c i-cacPwark.com / 763-569-4396 <br /> PROPERTY OWNER INFORMATION: <br /> Name: William (Bill ) P. & Cynthia (Cindy) J. Bowman <br /> Phone(day): 763-38377739 <br /> Address: 2230 So. Plymouth- Rd #205 City: Minnetonka ZIP: 55305 <br /> Email and/or Fax bbowman@lsi-csework.com / 763-999-4395 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Homeowner, William (Bill ) Bowman <br /> Phone(day): 763-383-7739 <br /> Address: <br /> 6 - - <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 d, <br /> ❑New ConstructionWater Supply <br /> Single Family with E]Residence <br /> ElAddition attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Seigle Family with ❑Deck <br /> ❑Relocation detached gage ❑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 /> Minnehahe Creels Watershed District(MCWD) ❑Other.(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-059D <br /> Fax: 952-471-0682 <br /> www.minrehahocreek.ora <br /> Estimated Construction Valuation(excluding land) $ 200.000 <br /> Last Updated: 4/26/2011 <br /> -19- <br />