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10/�3/20Q9 10:44 9524738680 DALBEC ROOFING I P GE e2103 <br /> . <br /> i ; t <br /> L ^1 ;I u � <br /> ,_ .. '-� � ..,r��� ,��� <br /> Ci of Orono � <br /> � <br /> , � <br /> , BWilding Per it Appllcation for Internal Wd��k � �� <br /> ' (windo�vs, doors, siding, r�-roof, etc.) �� ' <br /> Mailing ddress: 1 � <br /> Pertnit number. ; � <br /> O,�Q�O P Box 66 �' � <br /> Cr�etal Bay,MN 55323-0068 Date received: /� <br /> '� ' �✓ <br /> SfieetAddress: Received by: i; f �1— <br /> � a V <br /> ' o� 27 o KelleV Parkway Plan neview fee; �:' � <br /> ���ex� O�no,MN 55356 <br /> �`� I Tota(Fee: , �- <br /> Main: 95Q-249�600 Fax: 852-249�616 uv��vw.ci.o�ono.mn.us � ` <br /> This application form must be completed in full�and all required information must be s�a�mitte . <br /> Incomplete applications will be retumed. (Please print� <br /> pENERAL INFORIIAATION: <br /> Job Site ddress � <br /> � Will this a Parade of Homes, Remod�lers Showcase Home or other Display Home? Yes o <br /> lfyres,e Clal @r6nt pelml[IS IequuBd wff�Pof/v�Qeparlrneril and City Coun�ll epprwo/60 d�ye prior to tho ovenk C��i�►Na hus seNlCe WIII be <br /> requingd unless applicenf demonstrat�s suf/lclent on-sil�e parldng is evellable. Non-permitt�ed e�ts wil!notbs aUowed. <br /> CONTRA T�R/APhLICANT INFORMATI�N- , <br /> Name: �Au3E �c>F'��� �•►�- <br /> Sta�e Lic e# ,�%�Qy'1�� I Expiration Date. 3.-;�1-10 <br /> Phqne: 9�a-4�7 -S�Bo 1 office) �a=' -�'�� cell <br /> Ma;ling A dress: Sr Cit ; c.�t� LIr= <br /> Contact rson, ' L Applicant is: ontracto / Homeawner �c���e o�� <br /> ; Email an or Fax: ,� -a r <br /> '� pRpPER7Y OWN INFORMATION: <br /> �la�ne: �� <br /> Phpne (day): �5,�- `jt6-o�9L I — <br /> Addre,,: 1Db 4.L.,,?� 4i:� ,rr£ a I��C..� CitY: Ef�(r�A ZIP: <br /> Email andlor Fax <br /> PROJEGT INFORMATION: <br /> � Type of Project: Any earth movenr�ent may require <br /> i MCWD raevle+b��Permlts <br /> M� ❑Door(s) � O Remoae� ❑W��er Damago <br /> ; Minnehaha Creek Watershed Distrid(MCWD) <br /> '� Storm Damage 18202 MinnotGnka Blvd <br /> ; ❑Window(s) � ❑ Repalr � p�r��Pn,i'NJN 55391 <br /> i ❑Siding ❑ Restoration ❑Other. (specity) Phone: 952-471-0580 <br /> ; � Fax: 952��1-0682 <br /> ' e-roof ❑Fire pemogc www.minnehl'1lacreek.or <br /> Overall ProJect Descri tion: � � G � <br /> Estimated Construction Valuation of Prd ect excluding land) S vu �'a <br /> � ... \ ��1�,3�c`J <br /> i A LIC/ANT ACKNOWLEDGEMENT: <br /> j . A rees tv prvviJe all information requir�d or requcstcd by the Building Department; <br /> • Certifies that the information supplied is true and carrect to the best of hls/her knowledge. The applicant recognizes that they <br /> , are solely responsible for submitting a complete application befng aware that upon failure to do so, �he staff has no altemative <br /> but to reject it until it is complete; ' <br /> • Some or all oF the information that yo are asked to provide on this application is Uassified by St�1te law as either private or <br /> � confidentiel. Privatc dota i� i�formatidn which generally r��nrn bp given to the Dublic but can be qiven to the subject of the <br /> data. Confid�ntial data is infomiatlor� which generally cannot be given to eRher the publlc or the,subjed of the data. Our <br /> p rpose and intanded use of this infoknation is to annually update our recards and recorda of other govemmerrtal agencles <br /> uired b IaVrv. If ou rofuse to su I thp��fnm+ation,the a flCeUon ma not be issued. <br /> ApQlican Sfgnaturc: <br /> � � Date� 1 C� -1�"D� <br /> I aar Updat : 05-0�200g <br /> j, � <br /> E i � <br />