Laserfiche WebLink
Seo, 15, 2C11 ' 1 : 29n�ti1 tic. 6018 P, 2 <br /> "�t, ' � . <br /> C�ty af Qrono <br /> Building Permit Applicatlon for M�Intettance/Replacement/Remodel — Resldentl�l ONLY <br /> (I.e.wfndows,doors, siding, re-roof,etc.�NO STRUCTURAL EXPANSION) � <br /> ��n MailingAddr'ess: permit number. �/�/I �� <br /> PD Box 68 <br /> � Crysla)Bay,MN 55323-OOG6 Date received: <br /> Streef Add�ess: Received by: <br /> '�S � 2750 Kelley Parkway Plan rgViewfee: <br /> ���kESH��'�` Oronp,MN 55356 <br /> To1al F�@; I��Q� � <br /> Main: 952-249-46ao Fax: 952-249-4616 www.cl.orono.mn.us <br /> 7his applicati � be completed in full and all required information must be submitted. <br /> GENERAL INFORMATIO c lete pp Icatlons wltl be r urned. (please print) <br /> Job Slte Address; � D(� <br /> Will this be a Parade of H mes, emodelers S wcase Home or other Dlsplay Hame? ❑Yes No <br /> 1I yea,a special event perm+f rs required wrth Police Depa vnenl and Ciry CouncJf apprpv�l 60 days prior lo[he evenL Shutlfe bus servlce w!!I be <br /> �equ�red unless applia9nl demonsUates suflldenr on•sf(e parkfng!s available_ No�pe+milted events wil!nof be a!lowed. <br /> CONTRACTOR/A LIC NT INFORM 10 . <br /> Name: �1 � l� <br /> 5tate License# � Expiration Date: 3 <br /> Lead CertiCcalion Number� Expiralion Date� <br /> (for work on homea that wene consfr cte prlor fo 1978 <br /> Phone: (cell) � � � S (office) <br /> Mailing Address: �j Clty: ZIP: <br /> Contact Person_ e �, Applicant is: Contracto / Homeowner {ClrcleOne) <br /> Email andlor Fax: <br /> PAOPEFt7Y OWNE NF RMAT N: <br /> Name: �����„�r�� <br /> Phone(day): <br /> Address: � �� � CitY:�Jbhn ZIP:��,3�!_ <br /> Email and/or Fax: <br /> PROJ�CT INFORMATION: Overal! ro'ect descri tion� � < (�' �� �,�, <br /> Type of Project: Any earlh movement may also requlre <br /> MCWD�gY19W 8� ermlta: <br /> ❑�oor(s) ❑Remodel p Fire Damage P <br /> ❑Re-roof,aaphalt ❑Repalr ❑Slorm Damage Minnehaha Creek Walershed Qislrfct(MCWD) <br /> 15320 Mlnnelonka Blvd <br /> ❑Re-rooF,cedar ❑Resloration ❑Waler Damage Minnetonka,MN 55345 <br /> Phone: 852�7i-0580 <br /> �Re-roof,oth r(speclf� ❑Siding ❑Other:(specify) Fax: 952-471-b682 <br /> ❑Window(s) www.minnehahacreek.ora <br /> Estimated Constructian Valuation of ProJect(excluding land) $ <br /> APPLICANT ACKNOWI.EDGEMENT: <br /> • Agrees ta provide all informaGon required or requesled by Ihe�uilding Departmenl; <br /> • Ceriifies thal lhe infoRnallort supplled Is true and correct to lhe best of hismer knowledge. The applicant recognfzes Ihal they are <br /> solely responsible for s�bmitfing a complete applicalion being aware tha!uport Fellure lo do so,ihe staff has no alternative bul to <br /> reject it unlil il is complele; <br /> • Some or all of lhe informaGon thaL you are asked to provlde on lhis appficallon IS Classlfied by Sla[e Iaar as eiiher private or <br /> confidenlial. Private data is informaUon whlch generally cannot be given�o the puhiic but can be given to the subJect oI the dsta. <br /> Confidenlfal dala Is Informalion which generally cannot be given lo either the public or 11ie subJecl oF the data. Our purpose and <br /> Intended use oF ihis informalian is to annually updale our recards and records of olher governmenlal a8encies required by taw_ If <br /> ou refuse lo su I the informa�on,the a Ilcation ma not be issued. <br /> ApplicanYs Slgnature' Date: <br /> Owner's Signature: Date: <br /> Lasl Updafed:January 2016 <br />