Laserfiche WebLink
SE.P/22/2014/MON 04: 57 AM Elder Jones Building FAX No, 952 854 4909 P, 002 <br /> M <br /> City of 4rono <br /> Building Permit Application for Infiernal Wor � <br /> (windows, daors, siding, re-roof, etc.) � � ' � ' <br /> Mai/ing Address: � 2 Z, � <br /> ��,� PO Box 6fi Permit number <br /> Q Y � Gystai Bay, MN 55323-0066 �ate received: �� l�- C � U <br /> �?t' Received by_ <br /> � !,�'���;c,-�y �, 5treet Address' <br /> 3'J ��"� 4. 2750 Kel(ey Parfcwa <br /> � � Y Plan revfewfee: <br /> ?��"��t'ti�� Orona, MN 55356 � V� ;, <br /> �S�o� l 2 Z � <br /> Total Fee: <br /> Nlain: 952-249�6�0 Fax: 952-249-�4616 w+niw.,�j.or�n ;mn.us <br /> `I"his appfication fonr� must be completed in full and all required information must be submitted.��, j�L31�S <br /> Inaomplete application�w#(I be returned. (Please print) <br /> G�NERAL IN�ORMATION: _/ -/ � r <br /> Job Site Address: � 3 � a c�h�k �Y V �1 d V {d ` � �. <br /> Will fhis be a Par�de of Homes, Remodelers Showcase Home or ofher Displ�y Home? ❑Yes [] No <br /> IP yss,a speclal event permlt!s reqerlred wlth Pollce Department and Cfry Councl!approva!SO days prlor to ths event. Shuttle bus servrce will be <br /> requirecl unless appllcant d�moi�strat¢s suff]Gent on�slte parklnc�Js avalfabla. Non-permltted events wUI not b�allowed. <br /> GONTRACTOR 1 APPLlGANT INFORMATION: <br /> Name: �5?f�3tlS ' 4 aY7 <br /> State �icense# THD At-T�ome Se�t-vice, Inc, ' o�(, <br /> Phone: �� 26y0 Cunzbez-land Pk�vvy, Ste 300 (cen) <br /> Mailing Address: Af�at2ta, GA 30339-3913 Zlp: <br /> Contact Person� Lic# C.TZ268257��. 763/542-$$26 ��"�eowner �c���ieo�a� <br /> Email and/or Fax: <br /> PiZOP�RTY OWNER I�ORMATIO�a h b d ;n <br /> Name� O /3 <br /> Phone(day): G '9 i � • '.� Z i� <br /> Address� 0"2 3 � a �h � a!J 0 U C� D/ City:� 0/�� �Q �Q ZIP: 'S� S � S (s <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: ; Any earEh movernent m�y require <br /> ' � MCW�review&permits <br /> �..�oof(S) ❑ Remode[ ❑Wafer Damage � <br /> Mlnnehaha Creek Watershed C7istrict(MCWD) <br /> ❑ Window(s) Repair ❑Storm D�m3ge 18202 Minnetonka Blvd <br /> � Daephaven, MN 55391 <br /> ❑Siding ❑ Restoration ❑ OCher. (5pecify) Phone: 952-471�0590 <br /> � , Fax: 952-471-0682 <br /> ❑ Re-roof �] F�re Damage I www.minnehahacreek.orq <br /> Overatl Project Description: �� qr [ .0 C�D r rE rl C� d � O <br /> Estimated Construction Valuatiorc of Project(excluding land) $ y � �, � � <br /> APPLICANT ACKN4WL�DG�M�NT: <br /> . Agrees to provide afl infonration reyuirsd or requestecJ by the�uilding Department; <br /> • Certlffes that the information supplied is true and correct io the best of his/her knowledge. The applic2nt recognizes that they <br /> are solely responsible for submitting a complete application being aware that UF�On failUre to do So, CY1e StafF ha5 r10 altem2tive <br /> but to reject it until it is compiete; <br /> . Some or all of the information that you are asked to provide on this application is classifiEd by State law as eitlzer private or <br /> confidentia[. Private data is information which yanerafly ca�znot be given to the pubUc but can be given to the subject of the <br /> data_ Confid8nt��1 d�t3 is informatlon whiCh generally cannot be given to either the public or the suU)qCt of the d�ta. OUr <br /> purpose and intended use of this infomtation is to annual(y update our records and records of other gOvernmental agenCles <br /> reqUirgd by law. If you refU5e to supply the information,the appfication may not be issued. <br /> � 4� � � ��� <br /> AppficanYs 5ignature: �— Date: <br /> Las[Updated: OS-04-200� <br />