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City of Orono <br /> Building Permit Application \ ' <br /> for New Structures or Additions v <br /> — - Mailing Address: Permit number: OD/,S=.e)4007s <br /> O `\ PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /- d2 <br /> 11 '°' ' ` Received by: jam, <br /> \om` Z _ �, Street Address <br /> 4�. Gti� 2750 Kelley Parkway Plan review fee: 4/ �f, <br /> 4' 'o,ost, Orono, MN 55356 fie/S _ 7 rL <br /> �.�_�� <br /> Total Fee: <br /> Main: 952-249-4600 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 /> 245 Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: peS. Old Crystal Bay RD <br /> Will this be a Parade oomes, Remodelers Showcase Home or other Display Home? ❑ Yes jI 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: NIH Homes <br /> State License# BC419931 Expiration Date: 3-31-15 <br /> Phone: 763-753-1750 (office) 612-221-1853 (cell) <br /> Mailing Address: 6840 213th Ave City: Elk River ZIP: 55330 <br /> Contact Person: Colt Applicant is: ( Contracs / Homeowner (circle One) <br /> Email and/or Fax: colt@nihhomes.com Fax- 763-753-8582 <br /> PROPERTY OWNER INFORMATION: <br /> Name: NIH Homes <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Brad Kimpling <br /> Phone(day): 763-360-3956 <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑✓ New Construction ❑✓ Single Family with ID 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:(specify) ❑ Multiple Family/Condo 0 Warehouse <br /> 0 Public ❑ Storage 0 Public Water <br /> "Any earth movement may require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial ❑■ Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 500,000 <br />