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�� <br /> 4 <br /> , CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address.• Permit number. �b!(o—d U�'/ <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7— �`�'--/� <br /> Street Address:' �.--- ceived by: <br /> ,.� ,� _ ---- <br /> � G1 2750 Kelley Parkway ,� PJa�review fee: Q ��� <br /> �qk�$Hv�� Orono, MN 55356 .,�(� � � ��� _`��1 ; <br /> \__� Main: 952-249-4600 _— -fin�-���-- _ <br /> Fax: 952-249-4616 www.ci.orono.mn.us �`�"�-------�r <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 /> /f yes,a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuttle bus service wi/l 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: Craig Jansma � �-(.�e �E?C��c::r �j L;� � `� �� �o ��--� <br /> State License# BC 431870 Expiration Date: zois <br /> Phone: (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: craiaiCa�thelegacybuildingco.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: ' John and Donnette Tanner ' <br /> Phone (day): 612-747-0814 <br /> Address: 333 Hollander Road City: Orono Z�p: 55391 <br /> Email and/or Fax tannerfamily333@gmail.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Charles Levin Architects <br /> Phone (day): 612-729-5333 <br /> Address: 2300 Milwaukee Ave City: Minn anolis ZIP: <br /> 554f1d <br /> Email and/or Fax: Chuck clevin.com � <br /> S aM'� eYt�'�� ��� /' <br /> PROJECT INFORMATION: Description of project: �/ �:/�' � �M� " � /+'`�;;' <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 ; <br /> ❑Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage [�esidence <br /> ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water E <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> ❑ 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.or <br /> Estimated Construction Valuation (excluding land) $ 55,420.00 <br /> l,Qt�xG� t S �n�y ,�(/o;y�� ,-/����n,'��i�l�,p� 1'���1 a�,� ,---------- <br /> ;����i✓'�f� dl�fG� s��lly� � <br /> Last Updated: January 2016 <br />