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We <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0 Mailing Address: Permit number: ZQ 17— ZO `7 <br /> PO Box 66 <br /> Crystal Bay. MN 55323-0066 Date received: 7 <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: /Z0,75 <br /> Cgk£stio1`�` Orono. MN 55356 ::12\U1 --dU'�O <br /> 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 685 Old Crystal Bay Road N Long Lake. MN 55356 <br /> Will this be a Parade of Homes. Remodelers Showcase Home or other Display Home? ❑ Yes F±1 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: Ebert Construction <br /> State License# Expiration Date: <br /> Phone: (cell) 763-337-2950 (office) -7844 <br /> Mailing Address: 23350 County Road 10 City:Corcoran ZIP: 55357 <br /> Contact Person: Jed Nikula Applicant is: I Contractor Homeowner (Circle One) <br /> Email and/or Fax: inikula@ebertconst.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Orono ISD#278-Justin McCoy <br /> Phone (day): 952-449-8345 <br /> Address: 685 Old Crystal Bay Road N City: Long Lake ZIP: 55356 <br /> Email and/or Fax Imccoy@orono.k12.mn.us <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Jed Larson <br /> Phone (day): 763-682-9530 <br /> Address: 2381 Eaken Ave NE City: Buffalo ZIP: 55313 <br /> Email and/or Fax: larson.jed@gmail.com <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> 0 New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ® Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ 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 also require 0 Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) Q Other(specify) <br /> 15320 Minnetonka Blvd Parking/Storage Garage <br /> Minnetonka. MN 55345 <br /> Phone: 952471-0590 <br /> Fax: 952471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ 439.400.00 <br /> AUG 03 Z01 1 <br /> Last Updated: January 2016 CIN OF ORONO <br />