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CITY OF ORONO !`.L5 ,�, / � <br /> BUILDING PERMIT APPLICATION <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> %� Mailing Address: Permit number: 2O�� � OOL(�� <br /> ' ��NO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � � <br /> StreetAddress:' Received by: �-'�� <br /> 2�, � 2750 Kelley Parkway Plan review fee: l aG �,� <br /> t �,�' Orono, MN 55356 �; , , <br /> '�kESH�� _� / j=-CC l / Sl <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 w�:hi�h✓ci orono mn us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: / �"— � <br /> Job Site Address: � �� �����-� l�/ G'��� ��-,.0 /�C �r �h � C� C, �`�' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the evenk 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 /> Narpg: STONEBAY BUILDERS LLC <br /> State License# BC-sa�sos Expiration Date: 3i2o�s <br /> PhOfl@: (C21I� 612-363-4304 (office) 763-479-6926 <br /> MaIIICl9 AdCIf@SS: 14870 BROCKTON LN Clty: DAYTON Z�P; 55327 <br /> Contact Person: TOM osFaR Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or FBx: tomo@stonebaymn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: STONEBAY BUILDERS LLC <br /> Phone (day): �ss-a�s-ss2s <br /> AdCIf2SS: 14870 BROCKTON LN C�ty: DAYTON Z�P: 55327 <br /> Email and/or Fax tomno@stonebaymn.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: TOM osFaR <br /> Phone (day): s�2-ss3-asoa <br /> AddP@SS: 14870 BROCKTON LN Clty: DAYTON ZIP: 55327 <br /> Email and/o�Fax: tomo@stonebaymn.com <br /> PROJECT INFORMATION: Descri tion of f0�2Ct: New Single Family Dwelling <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 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 /> ��har �.�k::xc <br /> Estimated Construction Valuation (excluding land) $ z�s,000 <br />