Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
;t"x � s t <br /> City of Orono ,:�-;-� .� <br /> � Building Permit Application for Maintenance / Renovation �' ,3% <br /> �� <br /> ' (windows, doors, siding, re-roof, etc.) �� <br /> Mailing Address: Permit number. ° <br /> �,0,�. PO Box 66 i <br /> � �, 0 <br /> Crystal Bay, MN 55323-0066 Date received: x <br /> a i ���� a, Street Address: Received by: � <br /> �',�c,t �� �ti 2750 Kelley Parkway Plan review fee: ;`� <br /> RkESH�4� 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: f /� �� <br /> Job Site Address: < �� �-��� �l��r.�l��G�� 'f <br /> ' Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No � <br /> �', <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the evenf. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is avai(able. Non-permitted events will not be allowed. �":. <br /> �� <br /> CONTRACTOR/APPLICANT INFORMATION: o <br />�, Name: �= Z ��ow..� �-i(. �L� �; <br /> ; State License# �5 31 3�j Expiration Date: 3���'j -�j�,� ; <br /> � Lead Certification Number. Expiration Date: � <br /> (for work on homes that were constructed prior to 1978 x� <br /> Phone: l '"' 7� � (office) (cell) � <br /> Mailing Address: �t � � �(�S City: �. ZIP: ��� '� <br /> ��:' Contact Person: '�` ' Applicant is: Contractor / Homeowner (Circle One) y� <br /> Email and/or Fax: � <br /> . <"'. <br /> :�� <br /> PROPERTY OWNER INFORMATION: i <br /> Name: 1 � <br /> ��\� d��-e c� �3; <br /> Phone (day): ysoLSzc �� �� � <br /> Address: ���� � � �( o— City: ZIP: Y� <br /> Email and/or Fax `:� <br /> �� <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require � <br /> MCWD review 8�permits: ��' <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage Minnehaha Creek Watershed District(MCWD) �'� <br /> = �Re-roof, asphalt � Repair ❑ Storm Damage 18202 Minnetonka Blvd <br />.��5 ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 ; <br /> ❑ Re-roof, other(specify) ❑ Siding ❑ Other. (specify) Fax: 952-471-0682 <br /> a <br /> ❑Window(s) www.minnehahacreek.orp <br />��'� Overall Project Description: ��� <br />° ' Estimated Construction Valuation of Project (excluding land) $ <br /> ';� <br /> t APPLICANT ACKNOWLEDGEMENT: 'k <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; rt� <br />. � <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 :k�' <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 be issued. �: <br /> ` __ �s:. <br /> ' Applicant's Signature: Date: ����/ � <br /> ;� <br /> Last Updated: 08-09-2011 3-; <br />'. <br /> v � <br />