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� � �:� � � � `� ) <br /> CITY OF ORONO // // 5 3 , � � <br /> � `7�' �`' <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: ' :! <�)/j�- f;' ;f� <br /> � �O PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 t Date received: �'23' S <br /> StreetAddress:' � Received by: MT" <br /> 2� G� 2750 Kelley Parkway � Plan review fee: � j � �i 0�, J <br /> `� ��, Orono, MN 55356 .,{. ,� ,5- _dU`� <br /> l�k�SH� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 ww�,v ci crono r7in us <br /> This application form must be completed in full and all required information must be submitted. �.2D1 S-DD��7 <br /> Incomplete applications will be returned. (Please print) ,�;�5�,�C� <br /> GENERAL INFORMATION: - -�" ` <br /> Job Site Address: ��� ��`��'��S���"� t � �ti C�� ����� � � � �� <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 approva/60 days prior to the event. Shutt/e 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 /> Na�pe: STONEBAY BUILDERS LLC <br /> State License# sc-sa�3os Expiration Date: 3i2o�s <br /> Phone: (cell) 612-363-4304 (office) �63-479-6926 <br /> Malllflg Addf@SS: �4870 BROCKTON LN Clty: DAYTON Z�P: 55327 <br /> Contact Person: TOM osFaR Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/o�Fax: tomo@stonebaymn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: STONEBAY BUILDERS LLC <br /> Phone (day): �ss-a�s-ss2s <br /> AdC1f2SS: 14870 BROCKTON LN C�ty: DAYTON Z�P: 55327 <br /> Email and/or Fax tomno@stonebaymn.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: roM osFaR <br /> Phone (day): s�2-3s3-a3oa <br /> Addf2SS: 14870 BROCKTON LN Clty: DAYTON ZIP: 55327 <br /> Email and/Or FBx: tomo@stonebaymn.com <br /> PROJECT INFORMATION: Descri tion of f'O�@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 /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage X❑ Public Water <br /> ""Any earth movement may also require ❑ Commercial ❑Other(specify) <br /> MCWD review&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 /> vv�:��,:�i�rr,s,�enahacreekorr <br /> Estimated Construction Valuation (excluding land) $ 2�s,000 <br />