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� � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �--� Mailing Address: <br /> ; O Permit number: O�d�(o— U�/ �j <br /> � A, PO Box 66 <br /> % � `v(�� C stal Ba , MN 55323-0066 <br /> ; rY Y Date received: d —/� —/ <br /> � �� � Street Address:' Received by: <br /> �\, �� 2750 Kelley Parkway <br /> *',�� c,� Orono, MN 55356 Plan review fee: �..��j.�`. D <br /> ��kfsHo�� Main: 952-249-4600 Total Fee: d� ��" ���'3Z <br /> Fax: 952-249-4616 www ci orono mn us t ��y. ✓ <br /> This application form must be completed in full and all required information must b submitted. , <br /> Incomplete applications will be returned. (P/ease print) � �5,O IJ� �� <br /> GENERAL INFORMATION: � <br /> Job Site Address: 1220 Bracketts Point Road, Orono, MN 55391 L'�'"s`� `��g��� <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: Welch Forsman Associates Incorpora.ted <br /> State License# BC005890 Expiration Date: 03/2018 <br /> PhOn2: _�Cell) 612-221-0841(Peter Welch);612-221-0842(Don Forsman) (OffIC2) 612-827-4455 <br /> Mailing Address: 6026 Pillsbury Avenue South Cit : Minneapolis ZIP: MN 55419 <br /> Contact Person: Peter Welch/Don Forsman Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: Pete@WelchForsman.com ; Don@WelchForsman.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Elizabeth and Jule Hannaford <br /> Phone (day): 612-759-8011 <br /> Address: 1220 Bracketts Point Road City: Orono ZIP: MN 55391 <br /> Email and/or Fax Bhanna1891@aol.com ; Jhannaford@khblaw.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Kar-Keat Chong - Snow Kreilich Architects <br /> Phone (day): 612-752-0270 <br /> Address: 219 North 2nd Street Suite 120 Cit :Minneapolis ZIP: MN 55401 <br /> Email and/or Fax: ar- ea snow rei ic .com <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> �New Construction �Single Family with ❑Accessory Bldg. /Garage <br /> ❑Addition attached 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) � Othe�: (SpeCify) ❑ Other(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) $ 3,000,000.00 RECEIVED <br /> FEB � 0 2016 <br /> Packet Last Updated: August 2015 <br /> Page 21 (^,,m(OF ORONO <br />