Laserfiche WebLink
} r • <br /> City of �rono <br /> �ui[ding Permit Applic�tion for Maintenance 1 Renovation <br /> (windows, door�;, siding, reMroof, at�.) <br /> ��� Mailin0�ox 66� Permlt number: /� ^. d l� <br /> � � Crystsf Bay,MN�53�3-OU66 Date reGeL�d: �- �J`� � <br /> ,a a, SrreerAddress: Reoeived by: <br /> 275U Keiley Parkway plan tevEew fee: <br /> �i p$�.� Orono.MN 55356 <br /> Totsi Fee: ��U �� �1 <br /> Main: 952-2491t600 Fex: 952-2�4�4616 www.ci.orono,mn�u� <br /> This application farm must be campfeted in full and all required ir�formation must be submitted_ <br /> Incomplete appliaat7ons wifl be!'e'tum�d. (Please prirtf) <br /> GENERA�.ENPORMATION: � <br /> Job Site Address: �t�V�.`C � �•� 1 <br /> WIYI thls be a Parade af Homes, Rerttadeler9a Showcase Home or oth�rr Dispfay Home? Yes ❑ No <br /> Ny�as,a special evisnt permit is required with Police OBp�ttlr�Ernt and Cfly Coundl spprova160 days p�for to the ever� ShufHe bu8 9eMG�9►a�lll be <br /> required unless appllcant demonstrafes sufficieM on,8ite parking!8�veUabls. Non�emritted events w!H not be allowed. <br /> CONTRAC70Et/APPL�lCANT INFQRMATION: <br /> Name: �{. \ 'A �C.rSe�U <br /> State License# ���p9$-3 � _ �xpiratlon Date: 3��� <br /> Lead Cer�fic�tion Number: �j���. a'}�$3 -� Expiratbn bate: � <br /> (fior wiorK on homes�e#were construct�sd prior to 1978 -- -- <br /> Phone: (051� c� -�.Q$$� (office) (cetl} <br /> MaiiingAddress: ►• •� W�S�- CifY: �, � ZIP: SS1} <br /> ContacE Person: Appiicant is: n ra r / Homeawner (c�rci•onc> <br /> Emaii and/or Fax: � <br /> PROPERTY OVYNER IN�ORMATIQN: <br /> Name- A,�-Q. �Y10�S�i � <br /> Phone(day): �� -`�i�{ ,.6 ) <br /> Address: � Cfty: ZI P: <br /> �mail and/or�'ax <br /> PRQJ�CY INFORMATI�N: <br /> Type of project: Any earth movement may requ[re <br /> ❑ Dvpr{s) ❑Ftemodel ❑Flre Damage MCY1►D revlew 8�permfts: <br /> Minnehsha Creek Wa�rshed Dlstrict(MCWl7) <br /> C]R�roof,asphaEt ❑Repait ❑Sform Damage 18202 Mtnnatar�ka Blvd <br /> []Re-ro0f,Cedar ❑FZestoration 0 Water Damage Deephgven,MN 55391 <br /> Ph�na: 9ra2-47'l-0590 <br /> �Re-rovf.other(spectiy) (]Siding ❑Other.(specify) Fax: 852-471-0682 <br /> ❑Window(s) www.minn$hahacreek.orn <br /> Overall Project Descr�ption: �rL c 5 <br /> Estimated Constructlon Valuaticn of ProJect(excluding land} $ � $� -• <br /> ApPLICANT ACKNOWLEDGEMENT: <br /> . Agrees fo providB afl infcrmstion required or requested by the Building Department; <br /> • Cgritfie3 th�t the information suppt[ed is true arttf corr9CC t0 the bpst Of hlsJher knowledge. The applicant reCogNzeS th�t they <br /> ar+e sofely responslble for su6mfiUng a complete application being aware th8t upon fa�{ure to do so,the stafF has no aitemative <br /> but to r�eject ft urdtl R IB complete; <br /> • Some or sll of the InfiorrnaUon thst yau are asked to pravid�on this application Is classf�ed by State law as either private 4r <br /> cor�ffdentisl_ Private data Is Informaflon which generally cannot be gYerr to the pub�iC bui cen be given to ths subject of the <br /> date. Confiderrtial data is infarmation which generally cannot be given to elther the public or t3ie subjeci of the ri8ta_ Our <br /> purp�e and Ir�tended use of thfs informatiors is ta annually update our records snd rec�rds of other govemmental agenoies <br /> re ulred b law. ff ou refuse to su I the inftxmation,the a {ica#ipn rrr� nat be Issued. <br /> AoolicanYs Sidnature:�a,(,p�„�.vlr0� Date: ��� �� <br />