2011-00586 - re-roof - Laserfiche WebLink

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Jul. 5, 2011 4:48PM STOCK ROOFING 1631463621 No. 2806 P, 1 . City of Orono , Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc. Mailing Address� Permit number: 'l -0!5'S .� Og,�,�.0 PO eox 66 ... • Crystal Bay, MN 55323,0066 Date received: ' 7 S /� a � Strse�Address.� Received by: '�,r a� 2�5o Keney Parkway �Plan review fee: •tg�o�� Orono,MN 55356 •� . Total Fee� Main; 952-249�600 Fax: 952-249-4B16 www.ci.orono.mn.us � � This application fonn must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: O �<<�c � �.�� . _ Will this be a Parade of Homes, Remodele S�howesse Home or othe�Display Home? Yes No If yos,a speaal eveet permir is required with Police Department and City CouncU approvel 60 days pRor to the event. ShufHe bus service wdl6e required unless applicent demonsfreles sulficienf on-sife parkMg is available. Non-pemdtled evenfs wil►not be ellowed. CONTRACTOR I APPLiCANT INFORMATION: Name: %� ^ � State License# G � Zp';��.r Z Expiration Date: � r1� a ! Le�d Certification Number: EXpiration Date: (fw'work on homes that were constructed prloi to 1978 Phone; c3,7d p�� (,1 (office) (cell) Mailing Address: � /�y�, 'I� ,S' .e City: ZIP: �3 Z Cvntact Person: C �2 Applicarit is: on ctor Homeowner �ci�i.o�a� Email and/or Fax: � � ^ , � PROPERTY OWNER INFORMATIO Name; ��.. t�_ � S 1,c� . �. e✓I Phone(day): �.. �(,l� ^ Z� � Add�ess; 31�0 ��rr,n� ��p City, (y�� ZIP: ,�'s35'6 Email and/or Fax PROJECT INFORMATION: Type of Project: Any eartb movement may require ❑Door(s) �Remodel ❑Water Damage MCWD review 8 permits: Minnehaha Creek Wate�shed Dislrict(MCWD) ❑WindoW(s) ❑Repair ❑Storm Damage 18202 Minnetonka elvd ❑Siding ❑Restoration ❑Olher:(speafy) Deephaven,MN 55391 Phone: 952-1171-0590 �.Re-roof ❑ Fire Damage Fax: 952�471-D682 �v�cw.minnehahacreek.orQ Overall Pro'ect Desc�i tion: Estim�ted Construction Valuation of Prvject(excluding land) $ p�.s'po� APPLICANT ACKNOWLEDGEMENT: • Agr�es to provide all informalion required or requested by the Building Depardnent; . Ceriifies that lhe information supplied is true and correct lo lhe best of his/her luiowledge. The applicant recognizes that they are solely responsible for submitting a complet�application being aware that upon failure to do so,the staff has no alternative but to reject it until it is complete; • Some or all of the iniormetion that you ere asked to p�ovide on this application is classified by State law as either prnrate or confidential. Private d�ta is informalion which generally cannot be given to the public but can be given to lhe subject of the dsta. Confiderrtial data is inf�rmation which generally cannot be given to either the public or Ihe subject of Ihe data. Our purpose and intended use of thi ' ually updete our reco►ds and recoMs of othe�goVel"nmentdl agencies r uired b law. If ou re I the informat a li�tion ma not be issued. ApplicanYs Signature: - Date: CJ'�—t�S�Zo// Last Updated: 03-Ot-2011