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CITY OF ORONO <br /> � 5� ��/ '� '�- <br /> BUILDING PERMIT APPLICATION � , <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���� Mailing Address: Permit number: :,_�"� i" `:. <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 ( � Date received: <br /> Street Address:' ,, ��� Received by: <br /> % � 2750 Kelley Parkway � ° r�`'� Plan review fee: � �c�S,5 <br /> FlqkfSH���,�'\ Orono, MN 55356 ��V _._�..C?;._5 _�O/D5 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 wwvv ci oronc mr us <br /> This application form must be completed in full and all required information must be submitted. ;�"ti��/�-Cc !� I <br /> Incomplete applications will be returned. (P/ease print) .�`:�7.SGl . �t <br /> GENERAL INFORMATION: � .,� ��' <br /> Job Site Address: � �'1 ��� /� � 1�'L �i� � �k � � ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home. ❑ Yes ❑ No <br /> If yes,a specia/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 availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Narpe: STONEBAY BUILDERS LLC <br /> State License# ec-ss�sos Expiration Date: 3i2o�s <br /> PhOtl@: (C211) 612-363-4304 (office) �63-479-6926 <br /> M811111g ACldf@SS: 14870 BROCKTON LN Cjty;DAYTON Z�P; 55327 <br /> Contact Person: roM osFa,R Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/Or Fax: tomo@stonebaymn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: STONEBAY BUILDERS LLC <br /> Phone (day): �s3-a�s-s92s <br /> Addl'2SS: 14870 BROCKTON LN Clty: DAYTON ZIP: 55327 <br /> Email and/or Fax tomno@stonebaymn.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: TOM osFaR <br /> Phone(day): si2-ss3-asoa <br /> ACIdf2SS: 14870 BROCKTON LN Clty: DAYTON ZIP: 55327 <br /> Email and/or Fax: tomo@stonebaymn.com <br /> PROJECT INFORMATION: Descri tion of I'0�@Ct: New Single Family Dwelling <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> � New Construction ❑ Single Family with � Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. � Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Retocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage � Public Water <br /> *"Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> � hah �i�rvk ci� <br /> Estimated Construction Valuation (excluding land) $ 219,000 <br />