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� � <br /> City of Orono 7�� �� <br /> Building Permit Application ,� <br /> for New Structures or Additions �8a '� <br /> Marling Address: Permit number: +j2��C'" !iL> 7 Z� j <br /> O��.�0 PO Box 66 -- I <br /> Crystal Bay, MN 55323-0066 Date received: lU—��`�� <br /> � l;''�. a Street Address:' Received by: �06 <br /> ��c, %:.y '�. ; � 2750 Kelle Parkwa <br /> .,r,�.,..;�o Y Y Plan review fee: (,��'�a � <br /> r9��sHpg Orono, MN 55356 �3� � <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1225 Dickenson Street,Wayzata,MN 55391 <br /> ' Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑X No <br /> If yes, a special event permit is requrred with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suflicient on-site parking is available. Non-permitfed events will not be alfowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Michael Koch �/1/� � �-�-�a (�G. <br /> State License# 20628625 Expiration Date: 3/31/2011 <br /> Phone: (612) 867-3221 (office) (612)867-3221 (cell) <br /> Mailing Address: 22035 Iden Avenue North City: Forest Lake MN ZIP: 55025 <br /> Contact Person: Michael Koch Applicant is: X Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: Tom and Sarah Giel <br /> Phone{day): (612)867-3221 <br /> Address: 1225 Dickenson Street City: Wayzata,MN ZIP: 55391 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: DFP Planning and Design,LLC <br /> Phone(day): �763)780-8004 <br /> Address: 9100 Baltimore Street,N.E. City: Blaine MN ZIP: 55449 <br /> Email and/or Fax: CARMEL<INFO@DFPDESIGN.COM <br /> PROJECT INFORMATION: <br /> 1.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 ❑ OfficelCommercial ❑ Private Sewer � <br /> ❑ Other: (speafy) _ _ __ _. ❑ 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 District(MCWD) ❑ Other: (speciry) 3-Season Porch Addition <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> in r <br /> Estimated Construction Valuation {excluding land) $ 38,931.15 <br /> Last Updated: 9/29l2009 <br /> - 17- <br />