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. <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O ` _� Mailing Address: � C;>b�5 <br /> ��l PO Box 66 Permit number: �C/ <br /> Crystal Bay, MN 55323-0066 Date received: ��S � <br /> � <br /> � 6 a StreetAddress:' Received by: I�--1-� � � <br /> __ .__..._..._._. <br /> � 2750 Kelle Parkw " �� 'R' <br /> _�-- <br /> �, Plan review fee: . , �j�"�'~ �;� <br /> �lq �G` Orono, MN 55356 ��L GIS ' ����'� 3 {��J� i-1.2..�..(cd.—.._._– ��-. <br /> R ' <br /> ._.. _. _____ <br /> �5�� Total Fee--�-- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: 517 Ferndale Road N. Orono,MN 55391 <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 /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Denali Custom Homes Inc. <br /> State �icense# BC175394 Expiration Date: 03/31/2015 <br /> Phone: (cel►) 763-452-8347 (office) 952-476-2679 <br /> nnaiiin9 address: 18352 Minnetonka Blvd ci : ee aven ziP: 55391 <br /> Contact Person: Joe Mailhot Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: JOe's Cell Phone: �763)452.8347 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> rvame: Alexander Design Group <br /> Phone (day): 952-473-8777 <br /> address: 401 East Wayzata Blvd ciry: Wayzata ziP: 55391 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> � New Construction � Single Family with � Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ O�ce/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) ❑ Other: (speCify) <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) $ 1 ,3��,�lYU� <br />