Laserfiche WebLink
- - ro Cit of Or n � �7�/ <br /> �\1�� Y o o � 7 �Cv - <br /> Building Permit Application for Internal Worf� �r ;,� �,���f�wsF �, <br /> windows doors sidin re-roof . �.�``� <br /> ( , , g, , etc ) <br /> Mailing Address: Permit number: !D � /D � <br /> �g,�\ PO Box 66 <br /> �� : �O�\ Crystal Bay, MN 55323-0066 Date received: �D � / <br /> � � '�l <br /> a <br /> �`��� � �,i Street Address: Received by: <br /> �',�, � �': k`�`��� �ti 2750 Kelley Parkway Plan review fee: <br /> l9kE$H�g�' Orono, MN 55356 � � _ <br /> — Total Fee: �p/���`D <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: <br /> Job Site Address: � 8 c��CL.EL(/�/E p_{V —Q �C1--►1,�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I.NFORMATION: <br /> Name: �lTf-f W�"fE�S � p'C�SOC�l�P�1��' . !1�L <br /> State License# Expiration Date: 3' 3l— �IZ. <br /> Phone: — �{—L�'jQ office u t�, cell <br /> Mailing Address: �Z A — ( Cit : (z, z�P: 553�f <br /> Contact Person: —�.{� � L ,� Applicant is: n rac / Homeowner (Circle One) <br /> Email and/or Fax: I�EI�lSE l� � K�/Tff��?��-rS •COI� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �,�E�Sj�Ff- � �-/M���-f <br /> Phone(day): qSZ- YS�-55 SS <br /> Address: �(O�T R�DhF ��n_; �KK�'�c��s c�ty:ll�(i�n�.�,c����l,�S ziP: 55�34� <br /> Email and/or Fax -�-Crry Oo��u� •ecrU <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review&permits <br /> � Door(s) ❑ Remodel �Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> [�J Window(s) �'Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> (�Siding �Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: � ¢�� �,A�ti( �'(� (2.q�n�j <br /> Estimated Construction Valuation of Project(exc uding land) $ �$�vp d <br /> APPLICANT ACKNOWLEDGEMENT: <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; <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 <br /> purpose and intended use of this 'nformation is to annually update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to I the information,the a lication ma not be issued. <br /> Applicant's Signature: Date: IO'7 Z"—�� <br /> LastUpdated: 05-04-2009 <br />