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7 �� <br /> a l <br /> CITY OF ORONO � '� <br /> BUILDING PERMIT APPLICATION <br /> � � � <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> %c�� MailingAddress: Permit number: ��ll� QZ� .�/ <br /> / T�O�� PO Box 66 • <br /> � O Crystal Bay, MN 55323-0066 Date received: 7-` � 't—� � <br /> �,� � �C \�Y Street Address:' ceived by: <br /> '`rF C, / 1,� 2750 Kelley Parkway � %l� ,� P1 review fee: , � <br /> ��9'�F s ti��R�`� Orono, MN 55356 � ���, �� Q/� ��` J <br /> \�__i Main: 952-249-4600 Tota�Fee: ' <br /> Fax: 952-249-4616 www.ci.orono.mn.us ��C br,( <br /> _ <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: 333 Hollander Road <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 /> requir�d ur,!ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: �`T�. <br /> Name: Craig Jansma ,' —� (�� �C�C��c� �j �j��� � `� ��"�� ��� <br /> State License# BC 431870 Expiration Date: 2oie <br /> Phore: (cell) 320-290-4333 (office) <br /> Mailing Address: 14848 Kral Rd Cit : Minnetonka ZIP: 55345 <br /> Contact Person: Craig Jansma Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: craigj�a thelegacybuildingco com <br /> PROPERTY OWNER INFORMATION: �` ��` l� <br /> Name: John and Donnette Tanner �/�� � �Q C�q 1 C <br /> Phone (day): 612-747-0814 � ��'" J <br /> Address: 333 Hollander Road Q�������Q vi -�d�� <br /> Email and/or Fax tannerfamily333@gmail.com �`��� _ <br /> ������t �� �� ��� <br /> ARCHITECT/ENGINEER INFORMATION: /� / <br /> Name: Charles Levin Architects � � ��h � �� `C"m�� ; '— _ <br /> Phone (day): 612-729-5333 � <br /> Address: �300 MilwaukeeAve -�� �/� ��� �'? 7 �� — <br /> Email and/or Fax: Chuck@clevin.com ,_ <br /> J' �r <br /> PROJECT INFORMATION: Description of project: 9u4►/ �t � � r�• <br /> 1.Type of Project 2.Proposed Use . ,� ---- <br /> ❑ New Construction [�Single Family with [ <br /> [[�Addition attached garage [ <br /> ❑Accessory Building ❑ Single Family with [ <br /> ❑ Relocation detached garage L,._...,,....���� U Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) � <br /> ❑ Public 4-feet or greater ❑ Public Water � <br /> "*Any earth movement may also require ❑ Commercial ❑ Storage f <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well � <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 � <br /> www.minnehahacreek.orq / <br /> f <br /> Estimated Construction Valuation (excluding land) $ 55,420.00 ,�= <br /> , , <br /> � _ . , , <br /> , , <br /> . - � , <br /> l � .. <br /> <'�.�ct� , s C r! G' ��v y�n r�-�,��-���n ��,� (�°i9°��� �--- <br /> A ( . , � � �. <br /> . �^..�f��I^�� ��G'[/ �'� �� +4�j/ � V � <br /> Last Updated. January 2016 Y � <br /> \ <br />