2017-00282 - rubber roofing - Laserfiche WebLink

Home Browse Search

ti � City of Orono Building Permit Appiication for Maintenance / Replacement/ Remodei - Residential �NLY (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) Mailing Address: ��7:�Z8'a ��0 PO Box 66 Pertnit number: Crystal Bay,MN 55323-0066 Date reveived: � '��— � � Street Address: Received by: ti G� 2750 Kelley Parkway Plan review fee: `� Orono,MN 55356 `�kFSHo�`� d 70 03 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 informa6on must be submitted. Incomplete applications will be retumed. (Please print) GENERAL INFORMATION: Job Site Address: � `3�� S1 O l l�� L► ( � Will this be a Parade of omes, emodelers Showcase Home or other Display Home? Yes No H yes,a special ever►t pertnit is requirt9d with Pdioe Department and City Council approve/60 days prior to the ever►t. Shuttle bus servioe will be nsquired uNess applica�demons6ates sW�Cient on-site parldng is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Ptt�[,L�P 5 Z-�-e�2.�lJ/}/v �r,vN� i U�F'�5 �Yto��u/� _ �iUC� State License# ae�31 � � Expiration Date: 3 31 a 01 R Lead Certfication Number: ��?,...�p��p4_� Expiration Date: 3,�J JZ,pZt (for►�roe1r on homes that�construcfed prior to 1978 ' � Phone: (cell) ��'7 � a?(0'7 (office) Mailing Address: / � e cu�,�, /� City: ��/ ZIP: Contact Person: / � �/Z.� Applicarrt is: o r o / Homeowner �circiso�► Email and/or Fax: �Jj,�/,(aq-K��vA�O. C-�/�'� PROPERTY OWNER INFORMATION: Name: �fLL.I�}✓n � �£8�� /Urz�l9'�. Phone(day): (P l 2 3! O �7 g 6�/ `� Address: 1�c�7 j'Z�,y Pp!� C�iZ City: (��N� ZIP: �...�`�"�a�iT Email and/or Fax: W�pr��-(Z@ �.}�Ti'ytf�/L��n PROJECT INFORMATION: Overall ro'ect descri tion 5��- �"GN El, S�P� D F W b fZl� Type of Project: Any eartl�movement may also require �Door(s) ❑Remodel ❑Fire Damage MCWD review S permits: ❑Re-roof,asphalt ffi Repair ❑Storm Damage Mi�nehaha Creek Watershed Oistrict(MCWD) 15320 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration �Q,Water Damage Minnetonka,MN 55345 ❑Re-roof,other(specHy) ❑Siding ❑pther:(specify) Phone: 952-471-0590 Fax: 952-471-0682 �D(r) ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) S ! 3:50C> APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; • Certifi�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 complete application being aware thai upon failure to do so, the staff has no altemative but to rejed it until it is c�nplete; • Some or all of tlie information that you are asked to provide on this application is Gassified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given M the subject of the data. Confidential data is infoRnation which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this info tion is to annually update our records and records of other govemmental agencies required by law. If ou refuse to su I t rmation,the a li i n ma not be issued. ApplicanYs Signature: � Date: 3 2 7 �U/ Owne�'s Signature: Date: Last Updated:Jenuary 2016