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DocuSign Envelope ID:D095C6FC-BC6B-4772-8A5D-E021DAF4D0C8 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions /o <br /> �OA, Mailing Address: Permit number: {O_ � J <br /> V PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: al_213,1- l aZ <br /> Street Address: Received by: d <br /> A 2750 Kelley Parkway Plan review fee: •D ov <br /> e c` Orono, MN 55356 <br /> t�KfSH��� Main: 952-249 4600 Total p! 8^'-4 P4:6----.5- <br /> Fax: <br /> 952-249-4616 www.ci.orono.mn.us -5crOW 1 i a(),o <br /> This application form must be completed in full and all required information must be submitted. / U <br /> Incomplete applications will be returned. (Please print) 40 1 1-60457 <br /> GENERAL INFORMATION: <br /> Job Site Address: 2635 CASCO POINT RD, ORONO, MN 55391 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 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: EVERLAST ENTERPRISES INC <br /> State License# BC591566 Expiration Date: 3-31-2020 <br /> Phone: (cell) 612-868-0748 (office) 952-472-7287 <br /> Mailing Address: 4109 NORTH SHORE DRIVE City: MOUND ZIP: 55364 <br /> Contact Person: JIM CLEARY Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: JimEverlastEnterprises.com fax: 952-472-5870 <br /> PROPERTY OWNER INFORMATION: <br /> Name: PATRICIA REDMOND WEBBER <br /> Phone(day): 952-250-4482 <br /> Address: 15161 TECHNOLOGY DRIVE City: EDEN PRAIRIE ZIP: 55344 <br /> Email and/or Fax PATW2004@MSN.COM <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SHARRATT DESIGN <br /> Phone (day): (952)470-9750 <br /> Address: 464 2ND ST# 100 City: EXCELSIOR ZIP: 55331 <br /> Email and/or Fax: jlucasasharrattdesign.com <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ®New ConstructionWater Supply <br /> [�Single Family with ElAccessory Bldg./Garage <br /> 0 Addition attached garage ❑ Deck <br /> BuildingQ Public Sewer <br /> 0 Accessory ❑ Single Family with El <br /> ❑ Relocation detached garage in Residence <br /> El Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo El Retaining Wall(s) <br /> El Public 4-feet or greater ®Public Water <br /> **Any earth movement may require El Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial El Warehouse <br /> MCWD [' Private Well <br /> Minnehaha Creek Watershed District <br /> (MCWD) ElOther: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 650,000.00 RECEIVED <br /> APR IJ 1 `�-. "' ', ' <br /> Packet Last Updated: August 2015 L <br /> Page 21 <br /> CITY OF ORONO <br />