Laserfiche WebLink
, , �r <br /> � <br />�R � � • City of Orono £ <br /> - �. �.,� <br /> Building Permit Application for Internal Work <br /> '~ (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: • Q�O� <br /> 4v�,� PO Box 66 �'� <br />` � Q �,\ Q Crystal Bay, MN 55323-0066 Date received: Q Q J'� ` :, <br /> �'� Received by: /�f�j�{ � <br /> �� ���� F:�� F I Street Address: �+' <br /> � ti 2750 Kelle Parkwa � <br /> � pr` � Y Y Plan review fee: - <br /> �`�kEsxoQ'� Orono, MN 55356 � <br /> Total Fee: Q � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ���� U �`� <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 /> s,, Job Site Address: 3 �Sc� �,�dc�,e :,.�o��� C� �z . :� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No ��' <br /> '` !f 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 s� <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> .�`� <br /> CONTRACTOR/APPLICANT INFORMATION: � <br /> Name: No(z-���c�� CC���St2..��i�,�1 1..� C. <br />�`'� State License# � <br /> 2C�(�'�S� � �z Expiration Date: <br /> Phone: � <br /> � to'3 - �'1 co�-t -1 ti �S (office) (cell <br /> MailingAddress: � ,��z_k.,,�,� Cit : �,��,, > ZIP: 5 5 ) � <br /> Con tac t Person: `��bb" ��5��,� Applicant is: ontrac o / Homeowner (Circle One) ;� <br /> �� Email and/or Fax: `; <br />�., <br />�: . <br /> '� <br /> PROPERTY OWNER INFORMATION: }'. <br /> Name: �MA2_,�y.� E �e�e t.�;O ��� <br /> � <br /> Phone (day): ��S Z - �1 3Q�-�3�5 y _� <br /> r4 Address: 31 SC) SZ�a�.�� woo�{ C � �Z Cit : Q�Zprv p ZIP: S S 3 S� � <br /> `'' Email and/or Fax � <br /> ' � <br /> PROJECT INFORMATION: � <br />�� � <br /> Type of Project: Any earth movement may require '� <br />'�"' MCWD review&permits <br /> ❑ Door(s) ❑ Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) 4 <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd �� <br /> 3'� Deephaven, MN 55391 <br />� ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br />�� Fax: 952-471-0682 u <br /> e-roof ❑ Fire Damage www.minnehahacreek.orq <br /> y'- Overall Project Description: <br />'�� Estimated Construction Valuation of Project(excluding land) $ �-� � <br />'s'f, � <br /> '' APPLICANT ACKNOWLEDGEMENT: <br />�;: � <br /> • Agrees to provide all information required or requested by the Building Department; xs <br />`�'"� • Certifies that the information su lied is true and correct to the best of his/her knowled e. The a licant reco nizes that the `� <br />��`.� pP� 9 PP 9 Y <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 /> .�.. <br /> ;� <br /> • Some or alf 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 />�s': <br />� '� Applicant's Signature: ����(� �__� Date: i2- � ' �`7 <br /> r <br /> Last Updated: 05-04-2009 - <br /> ';. a �, , { . <br /> � , ,� <br />� .,m�� ,,,.• �� .,� ; ..���" .� .�s ,_-::: � w� � �����.���;r �. s <br />