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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION ��` �` �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: .�li % � • <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Received by: <br /> '\yf � 2750 Kelley Parkway Plan review fee: � 020 �.J� <br /> \�E ��,� Orono, MN 55356 �r- �Ol/ <br /> s�� Total Fee: �' <br /> Main: 952-249-4600 Fax: 952-249-4616 �n�ww ci orono mn us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will�e returned. (P/ease print) �, <br /> GENERAL INFORMATION: " <br /> Job Site Address: �� l�'���� U `z'�. � � �`' ,�7�r d � � �� � <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 available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Narpe: STONEBAY BUILDERS LLC <br /> State License# BC-681308 Expiration Date: 3i2o�s <br /> PhOC12: (Cell� 612-363-4304 (OffIC2� �63-479-6926 <br /> M8111f1g ACIC1feSS: 14870 BROCKTON LN Clty: DAYTON ZIP: 55327 �� <br /> Contact Person: TOM osFaR Applicant is: Contractor / Homeowner (Circle One) <br /> Em2il and/or F2x: tomo@stonebaymn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: STONEBAY BUILDERS LLC <br /> Phone (day): �s3-a�s-ss2s <br /> ACldf@SS: 14870 BROCKTON LN C�ty: DAYTON Z�P: 55327 <br /> Email and/or Fax tomno@stonebaymn.com <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> N8171@: TOM OSFAR <br /> PhOfle (d8y): 612-363-4304 <br /> ACICIf'ESS: 14870 BROCKTON LN Clty: DAYTON Z�P: 55327 <br /> Email and/or Fax: tomo@stonebaymn.com <br /> PROJECT INFORMATION: Descri tion of fO�eCt: 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 /> ❑ Relocation detached garage ❑ O�ce/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 /> �hat �ek or <br /> Estimated Construction Valuation (excluding land) $ 2�s,000 <br />