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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: `�C (J"�4( <br /> i��Q��, PO Box 66 <br /> Permit number: G <br /> � Q�� Crystal Bay, MN 55323-0066 Date received: 4 < <.! � � �� <br /> � �� <br /> 1 StreetAddress:' Received by: <br /> 1�:���� ,�,� 275o Keiiey Pa�k y 2����'0� i,)�y --� � .-� �3 , 1cf <br /> Plan review fee: <br /> ` ' �' Orono, MN 55356 ��� � �t2 - � <br /> ��kESHo� Main: 952-249-4600 � Total Fe <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in fu(I and all required inform tion must be submitte <br /> Incomplete applications will be returned. (Plea print� ��� ' �C� �d ��y�l�� q'���� <br /> GENERAL INFORMATION: �,� <br /> Job Site Address: 13�O Fox Street � J'�/��o� • <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 No <br /> /f yes.a specia!event permit is required with Police Department and City Counci!approvaf 60 days prror to the event. Shuttle bus service witl be <br /> required unless applicant demonstrates sufficrent on-site parking is availab/e. Non-permitted events will not be aDowed. _ <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Chamberlain Fine Custom Homes <br /> State License# BC661410 Expiration Date: 3/16 <br /> Phone: (cell) 9j?_f�4y-7653 (office) <br /> Mailing Address t 1578 Charnberlain Ct City:Eden P[�airie ZIP: 55344 <br /> Contact Person: Paul Camerou Applicant is: ontrac / Homeowner (Circle One) <br /> Email andlor Fax: Paut(u'�Chan�berlainca�.com <br /> PROPERTY OWNER INFORMATION: <br /> Name_ Chamberlain Capi�al LLC <br /> Phone (day): 952-64<)-7(,53 <br /> Address: 1 1578 Chambei�(ain CL City: Eden Prairie ZIP:»3�4 <br /> Email and/or Fax PaulCu'Ch�mberlaincap.com <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day}: <br /> Address: City: Z1P: <br /> Email and/or Fax_ <br /> PROJECT INFORMATION: Description of project: Teardown and new residential <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 ❑ OfficelCommercial <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&permits. ❑ Industrial ❑Warehouse � Private Well <br /> fv1innehaha Creek Watershed District(MCWD) ❑Other (specify) ❑ Other(specify) <br /> 15320 N1innetonka Blvd <br /> Minnefonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> 4vv�,�w.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �tiU,00i) <br /> Packet Last Updated. January 2015 <br /> Page 20 <br />