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City of Orono <br /> Bui{ding Permit Application <br /> �or New Structu�es or Additions <br /> �`� MaitingAddress: permit number. - � G�/�'" ����/ � <br /> //:�,Q 1����,. PQ B.nx�a6 <br /> �Y Crystal Bay,MN 55323-Ofl86 Date received: ��/ �/G� <br /> �O� "':. O� [�;,��t/��,/�/ � •_ � Received by: <br /> ,. ,j:'-,�- � tii:Ct3}".SJ'.7A'-'yy...S. <br /> �`�'.�,t �' � $�ti 2750 Kelley Parkway IPlan review fee: . ��% <br /> �„���� Orono,MN 55356 I <br /> � _-`' � �at$i�e�t: '�Cl l G� � �'�L� � � � <br /> Main: 952-249�600 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 /> tncomptetQ appitcations wii�De returned. (t�lease printj <br /> GENERAL INFORMATION: <br /> JobSiteAddress: 3200 North Shore Dr. <br /> Wi14 this be a Parade of Homes, RemodeSers Showcase Home or other Disp4ay Home? Yes No <br /> !f ye�s,a speciaf event permit is required with Police Department and City Couna/approval 60 days pnor to the event. Shutt/e bus service will be <br /> required unless applican2 demonstrafes su�cient on-site parking is a�ailab/e. Non-permdted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: First Street Const . , Inc . <br /> State License# 4 14 1 Expiration Date: March 3/31 /10 <br /> Phone: 952-442-4602 (o��e) 612-597-8661 (celp <br /> RAailingAddress: 417 F_ 1Gt STrPPt Clty:Gta�nnia ZIR: �,,"�R7 <br /> Contact Person: Jerrv Applicant is: Contractor ! Homeowner (CircleOne► <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: Barbara Halper <br /> Phone(day): 760-468-5468 <br /> Address: 3200 North Shore Dr. City:Orono ZIP: 55356 <br /> Email and/w Fax � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _ Autumn Design of Mn. Inc . <br /> Phone jday): 952-873-4311 <br /> Address: 19422 Whitetail Lane City:gellePlaine Z�P: 56011 <br /> Emai{and/or Fax: � <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> New Construction Water Supply <br /> ❑ �Single Famify with �'Residence <br /> �Addition attached garage ❑Garage/Accessory Bldg. (�Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other:(specifyj ❑ Multiple Family!Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> ""Any earth movement may require ❑ Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑Private Wel� <br /> Minnehaha Creek Watershed District(MC4VD) a Other:(SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> min r r <br /> Estimated Construction Valuation (excluding iand) a <br /> Last Updated: 9/292009 _ 17_ � �-. Q�Q Op <br /> ,�/ <br />