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�/`°"� . <br /> CITY OF ORONO <br /> - BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �A, Mailing Address: Permit number: /�"��-7Z� <br /> � �yO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �ls�/,$~ <br /> � � J SfreetAddress:' Received by: <br /> 2 � 2750 Kelley Parkway /I� ��. �� ian review fee: � � <br /> `� �' Orono, MN 55356 G �p 7 <br /> 1qkE'SH��� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in fu11 and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) , <br /> GENERAL INFORMATION: <br /> Job Site Address: 2755 Ethel Ave.,Orono,MN 55391 <br /> Will this be a Parade of Homes, Remodeters Showcase Home or other Display Home? ❑ Yes Q No <br /> H yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Everlast Enterprises,Inc. <br /> State License# BC591566 Expiration Date: 3-31-16 <br /> Phone: _�cell) 612-868-0748 (office) 952-472-7287 <br /> Mailing Address: 4�09 No Shore Drive City: Orono Z�P� 55364 <br /> Contact Person: _james Cleary Applicant is: on rac or / Homeowner (Circle One) <br /> Email and/or Fax: 952-472-5870 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Everlast Enterprises,Inc. <br /> Phone(day): 612-868-0748 <br /> Address: 4109 No Shore Drive City: Orono ZIP: 55364 <br /> Email and/or Fax iim@EverlastEnterprises.com <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: none <br /> Phone(day): ! <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro"ect: �-�� � <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction Water Supply <br /> � �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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (speCi(y) <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) $ � �:�S � <br />