Laserfiche WebLink
City of Orono <br /> � Building Permit Application for Internal Work <br /> � (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> O�v�,�0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ,� �� '�;- Received b <br /> . .4,:,.� �, StreetAddress: y� <br /> �'.�nt ' �'� G� 2750 Kelley Parkway Plan review fee: <br /> �kESH�g'� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.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: '3.�0 �t.-r�,<�'� p1 r �c�.vt,:� <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 event. Shuttle bus service will be <br /> required unless applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC�4NT INF�MATION: � , I � <br /> Name: _le1yL ��� �.a�}"(� <br /> State License# 'Zp(�'�'��30 Expiration Date: _3 � ( �o)Z <br /> Phone: (p[Z - zoZ - �37'Z. (office) (cell) <br /> Mailing Address: 94�p ,�u�1�.,�.1 �?�- City: (Zoc�.s5 ZIP: SS�3"74 <br /> Contact Person: ,..,�,�,� ,j������ Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���C;�. ���� <br /> Phone (day): �{SZ - -- y'7 �'� \ <br /> Address: (��>`� ,�.5 � � QcL�IR.,�;�;`c=.;.� City: C fr�,ci,51� ZIP: JS.3� <br /> Email and/or Fax � > <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review 8�permits <br /> �Door(s) `'�.Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> '�Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑ Re-roof ❑ Fire Damage C?�'�*�Q ��J�� www.minnehahacreek.orq <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) $ � p�� — <br /> APPLICANT ACKNOWLEDGEMENT: - <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to su I the information, the a lication ma not be issued. <br /> Applicant's Signature: Date: /�-�7�- f� <br /> Last Updated: 05-04-2009 <br />