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� � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��,, iO Mailing Address: Permit number. ��� � `�O � <br /> 1� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� I �j <br /> Sfreet Address:� ��-- <br /> �� � 2750 Kelley Parkw �,�;� �j—��)� i0 (��. 5� �� <br /> Plan review fee: � <br /> 1'k�S��R��' Orono, MN 55356 � <br /> Total 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 4565 Bayside Drive Orono,MN 55391 <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 on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Denali Custom Homes Inc. <br /> State License# BC175394 Expiration Date: 03/31/2015 <br /> Phone: cell 763-452-8347 (office) 952-476-2679 <br /> nnaiiing Address: 18352 Minnetonka Blvd ci : ee aven ZIP: 55391 <br /> Contact Person: Joe Mailhot Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: JOe's Cell Phone: (763)452.8347 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Ci : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: __ Alexander Design Group <br /> Phone (day): 952-473-8777 <br /> Address: 401 East WaVzata Blvd ciry: Wayzata ziP: 55391 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 7.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 <br /> � 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) $ 1,27�,0�0.00 <br />