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Oct 13 16 02:14p Tradition Roofing and Ext 651-698-3028 p.1 'r � ' Gity of Orono Building Permit Apptication for Maintenance/ Replacement! Remode!—Residential �NLY (i.e.win�iows, doars, siding, re-roof,etc.- NO STRUCYURAL EXPANSION) �O�TO MOailing Address: Perrnit number. 1 ' d�3 q 1 y PO Bux 66 Crystal Bay,MN 55323-0065 Date received: a � Sfreet Address: Received by. � • z � 2750 Kelley Pa�kway Plan review fee: "�� � " Orono, MN 55356 `�KfSH�� g, a Total Fee: Main: 952-249�600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required in#orrnafion must be submitted. Incomplete applications will be retumed. (P/ease prinf) GENERAL INFORMAT101�: Job Site Address: �f 7 '� ,�_j��_�_�__v�f,� n� WiN this be a Parade of Hom�,�temodelers Shclwcase Hame or ther Display Home? Yes No !f yes,a specia!everrt pemr'd is reqrurvd with Potice dapartment and City Councll approval 60 days prior to the everrt. Shultfe bus service wlll be requrred unless appficant demonstrafes suft/cieni onsite parkfng is available. Nort-pam►itted everNs w'r!!not be affowed. CONTRAC70R!APPLtCANT INFORMATION: Name: ��i�'ion �o01-rr�Gt Ar�(� ��(��#'"10✓'S 5iate License# ��-`�`��g�7 Expiration Date: 3��Z��7 Lead Certifiqtion Number: ��}-T Zt�yZ� —Z Expiration Date: yfz2 J�o2�' (for work on homes#hat were constrvcted prior to�978 Phone: (cell) (o�ce) _(� � n ' Mailing Address: City: ZIP: � G Coritact Person: ,,S'�.o.�.t- �r,,?�� Applicant is: ntractor ! Homeowner cc��o►�.� Email andlor Fax: .SC v�'��,�,�-i��a�i..,�. cs� PROPERTY OWNER INFORMATION• j� Name: �i C-�,C�JP_ *f- K_�n�' ��r r�S Phone(day): !o/ _- _�d- 5l6/� Z Aa�r�s: 7�' 7 7��d,�sc,� IQr� c�ty: Dr-ono ziP: ��9/ Email andlor Fax: PROJECT INFORMAIlOIV: Overall project descri tian: Type of Project: I Any earth movement may also require ❑Daor(s} ❑ Remode) ❑ Fire Damage I MCWD review 8 permits: �Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed Districk(MCW D) 45320 Minnetonka 8ivd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka,MN 55345 ❑ Re-roof,oRher(specify) ❑Siding ❑ Other:(specify) Phone: 952-471-0590 Fa�c 952-471-0682 ❑Window(s) www.minnehahacreek.ora Estimated Consfruction Valuation of Project(exciuding land) $ l o y on APPLICAN7 ACKNCIWLEDGEMENT: • Agrees ia pravide alt information�equired or requested by the Building Department; • Certifies that the informafion supplied is true and coRect to ihe best of his/her knowledge. The appl�cani recognizes that they are solely responsible for submitting a complete appliqpon being aware that upon failure to do so,the staff has no aftemative but to reject it untif it is complete; • Some or all of the information that you are asked to provide on ihis application is classified by State law as either private or confidentiat. Pmrate data is inforsnation which generally cannot be given to the public but can be given to tfie subject of the data. Con�idential data is informaUon which generaNy cannot.be gfven to either the public or the subjecl of the data. Our purpose and intended use of this informat�n is to annually update our rec;ords and recorcls of other govemmental agencies required by law. If re(use to su I the information,the a lication ma noi be issued. ApplicanYs Signature; /�'" Date: ��f I Z��/�+ Owner's Signature: Date: i.ast Updated:JanuaryZOt6