2014-01254 - windows - Laserfiche WebLink

Home Browse Search

City of Orono Building Permit Appiication for Maintenance / Replacement / Renovation �(No structural expansion. Only windows, doors, siding, re-roof, etc.) �O�O Mailing Address: Permit number: PO Box 66 Crystal Bay, MN 55323-0066 Date received: Streef Address: Received by: y� G; 2750 Kelley Parkway Plan review fee: Orono, MN 55356 �'�KssHo��' Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incompfete applications will be returned. (Please print) GENERAL INFORMATION: JobSiteAddress: �' ��7 Q�2S-� �O��r- ��;�'�\� � C�('cat�c'� . (�1'1rU: C�:3�`f Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,� No If yes,a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficienf on-site parking is available. Non-permitted events wilf not be allowed. CONTRACTOR!APPLICANT INFORMATION: Name: C�,-t-O:'� (� �o. � 1 �1C State License# _��+ �-��L{- �� Expiration Date: "31 � S Lead Certification Number: �.7-=�i ��{..'� _� Expiration Date: �j , �_ (for work on homes that were constructed pr►or to 1 78 —�� Phone: (cell) �t��s� ��J� C�'�� (office) �L��c:�3��.-�Z-��j Mailing Address: —� �. � . City: ZIP: �-�- - c Contact Person: �� \ Applicant is: Contractor / Homeowner (Circfe One) Email and/or Fax: �� ., ��L�{ ('�;\� `� "�� M ��.� PROPERTY OWNER INFORM�ION: Name: � ,n - Phone (day): - O Address: \�v-� e S� �r1.� L:,'�� City: �`�� ZIP: ��.oy Email and/or Fax: ��T� PROJECT INFORMATION: Overall pro ect description: �'ype of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 �..Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding fand) $ U APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a compfete application being aware that upon failure to do so, the staff has no altemative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If ou refuse to su I th information, the a lication ma not be issued. App(icanYs Signature: c� � �) Date: /C��T�� Own�r's Signature: Date: Last liodaied: 03/06/2013