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� � <br /> � ' ' CITY OF ORONO � <br /> BUILDiNG PERMIT APPLICATION <br /> � � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �. �A_',` Mailing Address: Pertnit number. ����0' �T /�{,� <br /> �� .��'V�'`_,, PO Box 66 Date reoeived: �� — ,�7 <br /> 1 Crystal Bay,MN 55323-0066 <br /> i ' y <br /> � i Street Address:' eceived b : 'Y� <br /> .1`,.;�� :;' 2750 Keliey Paricway i� Plan reviewfee: O�SI• �p �' <br /> ` t" Orono,MN 55356 ,� �/ <br /> ` ���r���.,�,: p�Q(i6-OC, T� <br /> _. _ Main: 952-249-4600 lij Total Fee: <br /> Fax: 952-249-4618 wwv+ci.oronb mn us ES(rA,�( ✓ <br /> This application form must be completed in full and aii required information must be su ed. <br /> Incomplete applications will be returned• (Piease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3414 livin ston Avenue Orono, MN 55391 <br /> Will this be a Parade of Homes, Remodeters Showcase Home or other Dispiay Home? Yes ■ No <br /> if yes,a special event permit rs reQurred with Police Department and Gty Counpl approva/60 days prior to the event. Shuttle bus�rvice wiU be <br /> requir�d un/ess applicant demonstrates sufficient on-srte parlUng is availeble. Non-pevmiKed events wil/not be al(owed. <br /> CQNTRAGTOR/APPLiCANT INFORMATION: <br /> Name: Westem Construction inc. <br /> State License# BC316811 Expiration Date: 4-1-18 <br /> Phone: (cell) 612-306-8888 (office) 952-920-$888 <br /> Mai�ing,4ddress: d301 HiQhway 7#115 c�y: Minneapolis ZiP: 55416 <br /> concact Person: Bradley Chazm Applicant is: Contractor / Homeowner �c+.c�o�� <br /> Emaii and�or Fax: bradCc�westemconstructioninc com <br /> PROPERTY OWNER INFORMATION: <br /> rvame: Caren & Carl Borg <br /> Phone(day): 952-471-0843 <br /> Address: ��� � ��rinaStan Av����p C�y: OrOnO z�P: 55391 <br /> Email and/or Fax .CbOf�luflo.00171 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone{day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATIOPI: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage D�poaal8 <br /> Water Supply <br /> 0 New Construction ❑Sing�Family with �Accessory Bldg.J Garage <br /> ❑Addition attached garage ❑Deck ❑Public Sewer <br /> �Acxessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑RelocaGon deffiched garage ❑Residenoe ❑Rrivate Sewer <br /> ❑Other:(speay) ❑Muftipte Family!Condo ❑Retaining Wall(s) <br /> ❑Public 4-feet or greater ❑Public Water <br /> "My eartfi movemerrt may also require ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑Industrial �Warehouse ❑Private Well <br /> Minnehaha Creek Watershed Distrid(MCWD) ❑pther.(spedfy} ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952�d71-0682 <br /> wwv�minr.ehahacreek.or <br /> Estimated ConsWction Valuation{excluding land) s $21.466.00 <br /> Last UDdated• Januarv 2016 `�"�(�!�=!I�Gf��� <br /> �J__�. . <br /> APR� 2 � ZOi6 <br /> cm�oF oRorvo <br />