2016-01325 - windows - Laserfiche WebLink

Home Browse Search

��,('CT�12/2016/WED 03: 13 PM Elder Jones Building FAX No. 952 854 4909 P, 002 . C�ty of Orona Building Permit Application for Maintenance/ Replacemcnt/ R�mod�E- Residentf�l QNLY (i,e. windows, doors, siding, re-roof, etc. -NQ STRUCTURAL EXPANSION) �("�A rQ Mailing Address: permit�umber: �Iv d� i 1 V PO Box 66 Crystal Bay, MN 55323-0066 �,0 Date recelved� d- —/ Street Address: �� Received by: �� ti�' 2750 Kelley Parkway �� b� Plan review e: � Orono,MN 55356 � /� � �RRFs�l o��' Total Fe �, � Ma{n: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must ba completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: a� ,7 � Job Slta Address_ S Q � !,� O o q Q Q� Will this be a Parad�of Homes,Remodelers Showc se Mome or other Display Home? Yes No !f yes,a specia!sveni permlt is requfred with Pofice Department and Clty CounGl approva!60 days prlor to the event. Shuttle bus Servlca will be requiled un/esa applicanf demonstratea suf�iciertt on sRe perking is available. Non permitfed events wiR not be a!lowed. CONTRACTORlAPPLICANT INFORMATION: Name: State License# Pe12a Notthlaucl Expiration Date: �ead Certificatian Nu XS300 2Sth Ave N. Ste l00 Expiration Date: (for work on hame; p1yxxaoutX�,MN 5544'7 Phone: ( Lic#BC645090 Ph. 763/745-�400 (office) Malling Address: Cit : ZIP: Contact Person: 5� y� , � 0 7 Applicank� � Contractor / Homeowner �c�r��a o�a� Email and/or Fax: �� qt j S �0 � � �Q � ��n d S, ('p /�y PROPERTY OWNER FOR AT10N: /� Name: l� ��1 4. �5 � b e!'� 0 /) Phane(day): g'S 9 Y X J • 9' o S 9 � * / Address: 'j Q a v O Q City: W d Z a'7`a ziP: 5'S3 9/ �mail and/or Fax: PROJEC7 INFORMATIOAI: Overall project descrip#ion; Type of Pro'eck: Any earth movement may also require �,,/ MCWD revtew�permlts: LJ Door(s) ❑Remodel �Fire Damage ❑ Re-roof,asphalt [�Repair ❑Storm Ramage Nlinnehaha Creek Watershed Dlstrict(MCWD) 15320 Minnebnka Blvd ❑Re-roof,cedar ❑F2estoration ❑Water bamage Minnetonka,MN 55345 Phone; 952-471-0590 0 Re-roof,other(specifyr) ❑Siding � ❑Other: (specify) Fax: 952�471-Ofi82 �]Window(s) � www i e a acreek.or Estimated Constructien Valuation of Project(excluding land} $ ��, $ � '�' APPLICANT ACKNOWLEDGEMENT: . Agrses to provide all information required or requested by the Building Department; . Certifies that the Infarmation supplied is true and correct to the best of his/har knowledge. The applicant recagnizes ihat they are solely responsible far submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; • Some ar all of tha information that you are asked to provide on this application is classifled by State law as elther private or confidential, Private data is inFormation which generally cannot be glven to the pubflc but can be given to the subject of the data. Confidential data is information which generally cannot be given to elther the publlc or the subject of ti,e data. Our purpose and intended use of this information is to annually update our records and r2cords of other govemmental agencies required by law. If ou refuse to u the informatlon the a lication ma not be issued_ Applicant's Signatur �� Date: � � �� ! �L Owner's Signature: pate: Last Updated:January 2016