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' CITY OF ORONO <br /> � BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: Permit number. G C�� ��� J- <br /> �"�`vO PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: {�"1 Z'�'� <br /> ., � Street Address:' C ` � ��� eceived by: !� ` <br /> ��.! �. 2750 Kelley Pa y �(; ` `P v �' lan review fee: �5• <br /> q,�FSH���c. Orono, MN 55356 � , _ .. <br /> Main: 952-249-4600 --�� o-T-�aT�ee� <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 submitted. <br /> Incomplete applications witl be returned. (Please print) <br /> GENERAL INFORMATION: <br /> JobSiteAddress: 94o North Arm Drive, Orono, MN (PID# 07-117-23-11-0014) <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►equired with Police Department and City Council approval 60 days prior to the eveirt. Shuttle bus service will be <br /> required unless applicant demonsbates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: villamil Construction Co. <br /> State License# BC633780 Expiration Date: o3/3i/2o1� <br /> Phone: (cell) 612.221.7511 (office) <br /> M2111ftg Addf@SS: 5535 CR 151 Clt : Minnetrista ZIP: 55364 <br /> Contact Person: Ian villamil Applicant is: Contractor Homeowner (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION; <br /> NBme: Roman Olshansky <br /> PhO�@(d2y): 612.296.0409 <br /> Address: 14545 7th Ave N City: Plymouth ZIP: 55447 <br /> Email and/or Fvc romanolshansky26@gmail.com <br /> ARCHITECT/ENGINEER INFORMATtON: <br /> Name: Kevin Factory Home Center <br /> PhOfte(d8y): 507.644.2115 <br /> Address: 2e5o2 State Highway 55 East City: Paynesville ZIP: 6362 <br /> Email and/or Fax: kevinc�factoryhomes.net <br /> PROJECT INFORMATION: Description vf ro�ect: � P`'`'' � � �f"� �y�- <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 � Public Sewe� <br /> ❑Accessory Building � Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> 0 Other: (specify)Manufactured hom ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "*Any earth movement may also require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse Qx Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) �Other(specify) <br /> 15320 Minnetonka Blvd Manufactured Home <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) a 145,o00.o0 <br /> Last Updated: January 2016 <br />