Laserfiche WebLink
. t <br /> . � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> _ _ Mailing Address: ����/ a�� <br /> PO Box 66 Permit number: <br /> � �O�Q\� C stal Ba MN 55323-0066 <br /> rY Y� Date received: ���'� � <br /> � - <br /> 1 Street Address:� Receiv : _ <br /> � ' = 2750 Kelley Parkway <br /> �' ,� � Orono, MN 55356 (�d L� i I �-/ ��an review fee: ll <br /> ������c�ti',{�,�t`� Main: 952-249-4600 07�15 - O/o� � <br /> �_f__- Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.rrin.us <br /> This application form must be completed in full and all required information mu t be submitted. �Y� <br /> Incomplete applications will be returned. (P/ease print) -� �,�� <br /> GENERAL INFORMATION: �/� � <br /> Job Site Address: 4565 Bayside Road Orono, MN 55356 <br /> LYy'=:_� i�-j��� �`=� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑X No <br /> lf 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# BC 175394 Expiration Date: 03/31/2015 <br /> Phone: (cell) 763-452-8347 (office)952-476-2679 <br /> nnaiiing Address: 18352 Minnetonka Blvd ci : Dee haven ZIP: 55391 <br /> Contact Person: Joe Mailhot Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: �Oe's Cell Phone: (763)452.8347 <br /> PROPERTY OWNER INFORMATION: <br /> tvame: Tim and Mary Doubek <br /> Phone (day): Tim's Cell Phone: (612)801.3076 <br /> address: 17046 Valley Road ciry: Eden Prairie ziP: 55347 <br /> Email and/or Fax tjdoubekCa��mail.cc�m <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: - �' <br /> 1.Type of Project 2. Proposed Use 3.Structure Type �� 4.Sewage Disposal 8� <br /> ,�fa�-<� � Water Supply <br /> ❑ New Construction � Single Family with �Accessory Bldg. arage j <br /> ❑ Addition ..�..�ttaeh�"garage ❑ Deck ❑ Public Sewer <br /> � Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ($� Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse � Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Othef(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 58,90�.00 <br /> � <br /> Packet Last Updated: August 2015 �:j���(� <br /> Page 21 <br />