HomeMy WebLinkAbout2014-01474 - adv plan review CITY OF ORONO PERMIT NO.: 2011-01474
2750 KELLEY PARKWAY
. • � ORONO, MN 55356- �ATE 1SSUEn: 1U23/2011
' 952 249-4600 FAX: 952 249-4616
ADDRESS : 805 FOREST ARMS LA
PIN : 07-117-23-12-0009
LEGAL DESC : FOREST ARMS
: LOT 001 BLOCK 002
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 250,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OP PERMIT: $ 2�0,000.00
TYPE OF PERMIT"I'HIS PAYMENT IS FOR: BUILDING PERMIT,PARTIAL REBUILD OF HOME
PERMIT#THIS PRL-PAYMENT IS TIED"1'O:201 1-01475
APPLICANT ADVANCED PLAN REVIEW 1,271.89
GURALNIK,ALBERT& VALERIE TOTAL 1,271.89
805 FOREST ARMS LA
MOUND, MN 55364
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OWNER : "r��� M�a =, ,. _ �:�;_ ;.;. _
GURALNIK,ALBERT&VALERIE - �
.�ipt i�a: �.�'r,c,;-:�,� t;,,,.: -:,,
805 FOREST ARMS LA �
MOUND, MN 55364
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'<:'�IGUS �31aY;;:�:
AGREEMENT AND SWORN STATEMENT =?'«i�� _
�"_i-tli4i4 905 �=ot e5t : :.
The work for which this permit is issued shall be performed according to _,.,,� �d
the approved plans and specitications,applicable City approvals,and the �-3�t41{1
State Buildina Code. This permit is for only the work described and does � 1p C}�eCK,/�s1�@ FXdhi F8e5
not grant permission Yor addi[ional or related work which requires separate
permits. All provisions of laws and ordinances governing this typc of work _-;,�j; .
shall be compied with whether or not specified herein.This permit will --�
' ,r
� . . + City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: aO/�_
/�.+0,�� PO Box 66 Permit number. 6�� 7�
/0 ��\ Crystal Bay, MN 55323-0066 Date received: ���Z����
�,,, 1
I ��h��'� I Received b ,,� � �L.—
l� `��' o. Street Address: o�f�U ( '7�f Y� �' �'
� �.:��� � � Y
��,n �"'� �ti ' 2750 Kelley Parkway � ��Z�l l � P�n�r�e�w fee: ��� � �f�• �9�
L�'kESH04'� Orono, MN 55356
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incompfete applications will be returned. (Please print)
GENERAL INFORMATION: �D � �OrP �� ��rns ! w ,
Job Site Address: UV
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
If yes, a special event permit is required with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name:
State License# Expiration Date:
Phone: (office) (cell)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER I FORMAT�N:
Name: �l�jC2, �GG�lZC�IV� �
Phone (day): �SZ �l,�3 �56 2 G
Address: $OS �"o/us� �.�r�c' �i�i�� City� ����� � ZIP� t j�G ly
Email and/or Fax �c, � �! ,'L ,-+-�
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP�
Email and/or Fax:
PROJECT INFORMATION:
1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
❑ New Construction m le Famil with Water Supply
[�,5� g y � Residence
❑Addition attached garage ❑ Garage/Accessory Bldg. [� Public Sewer
❑ Accessory Building ❑ Single Family with ❑ Deck
� Relocation � , detached garage ❑ Office/Commercial
Other.(specify) �+v✓ Q� �� ❑ Multi le Famil !Condo ❑ Private Sewer
p y ❑Warehouse
Ce� �,��i(�f ❑ Public ❑ Storage ❑ Public Water
**Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review&permits. ❑ Industrial �Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify)
18202 Minnetonka Blvd
Deephaven, MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.or
Estimated Construction Valuation (excfuding land) $ 2,�0� Od�J� o��
Packet Last Updated: 10-20-2011
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