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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: o�O/�_ O/50 5 <br /> 0 PO Box 66 Permit number: �/ <br /> O A1O Crystal Bay, MN 55323-0066 Date received: ��' �"17 <br /> Street Address:' Received by: <br /> '' 2750 Kelley Parkway / �� 9 <br /> 11,011E- <br /> y� Plan review fee: <br /> c> Orono, MN 55356 <br /> �'IKesHo9``` Main: 952-249-4600 Total Fee: 11104 r7-6 150E— <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 will be returned. (Please print) ---60- 0 <br /> i/0 <br /> GENERAL INFORMATION: p'!,�/ <br /> Job Site Address: 3444 East Lake Street, Orono, MN 55356 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? E 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: Revision LLC <br /> State License# BC639027 Expiration Date: 3/31/2018 <br /> Phone: (cell) 612-710-7236 (office) 612-462-4000 <br /> Mailing Address: 153 Lake St E City: Wayzata ZIP: 55391 <br /> Contact Person: Kevin Shultz Applicant is: cContractot / Homeowner (Circle One) <br /> Email and/or Fax: kevin@revisiommn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Jean M Braun <br /> Phone (day): <br /> Address: 14342 Harbour Landings Dr, Unit C City: Fort Myers, FL ZIP: 33908 <br /> Email and/or Fax braunjm@comcast.net <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> El New Construction RrSingle Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck MtPublic Sewer <br /> El Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑_Relocation detached garage ❑ Residence ❑ Private Sewer <br /> Other:(specify) Interior Remodel ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public 4-feet or greater El Public Water <br /> **Any earth movement may require ❑Commercial ['Storage <br /> MCWD review&permits. ❑ Industrial Q.Warehouse VPrivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) Other(specify) <br /> 15320 Minnetonka Blvd Screen porch add'n Ex' utilities remain <br /> Minnetonka,MN 55345 g <br /> Phone: 952-471-0590 as/is. <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> $ $192,000.00 RECEIVED <br /> Estimated Construction Valuation (excluding land) <br /> NOV I 5 2017 <br /> Packet Last Updated: August 2015 <br /> Page 21 CITY OF ORONO <br />