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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ,.___�. Mailing Address: o�p� -�_��S 3 7 <br /> /� QA, PO Box 66 Permit number: <br /> / �' `�� Crystal Bay, MN 55323-0066 Date received: ,,�-�a -/ <br /> +� � �^ <br /> ( J Street Address:� Received by: �f�" ��/ <br /> i R , ,� 2750 Kelley Parkway Plan review fee: �� ���. v <br /> . <br /> l��t� ��`� Orono, MN 55356 o�d 7 - DO�3 <br /> �,,�c�HcJ,/� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be� � d. <br /> Incomplete applications will be returned. (Please print) � ; \`J <br /> GENERAL INFORMATION: <br /> Job Site Address: 1095 Ferndale Road West ''� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? es � 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: Welch Forsman Associates Inc <br /> State License# BC005890 Expiration Date: 3/31/2018 <br /> Phone: (cell) 612-221-0842 (office)612-827-4455 <br /> Mailing Address: 6026 Pillsbur Ave So Cit : Minnea olis ZIP: 55419 <br /> Contact Person: Don Forsman Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: don@welchforsman.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Bill Toles <br /> Phone (day): 952-240-2100 <br /> Address: 2510 Crescent Ridge Drive City: Minnetonka ZIP: 55305 <br /> Email and/or Fax wtoles1041 na aol.com <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Jean Rehkamp Larson, Rehkamp Larson Architects <br /> Phone (day): 612-285-7575 <br /> Address: 2732 West 43rd St City: Minneapolis ZIP:55410 <br /> Email and/or Fax: jeanCa�rehkamplarson.com <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑X New Construction X❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck �X Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑X 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 8�permits. ❑ Industrial ❑Warehouse X❑ 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) <br /> $ 3,500,000.00 R�� <br /> �°lr�� �2 Z <br /> Packet Last Updated.� August 2015 CITY OF OR41�E4 <br /> Page 21 <br />