Laserfiche WebLink
- ' City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: �� - /� <br /> 4v 0,� PO Box 66 <br /> � ` Q Crystal Bay, MN 55323-0066 Date received: �] / <br /> a� ��� :��.i �, Street Address: Received by: <br /> �'�,n `� ''� �,ti�' 2750 Kelley Parkway Plan review fee: <br /> t9kESFio�'� Orono, MN 55356 <br /> Total Fee: <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: <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 approva160 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 INFORMATION: <br /> Name: a ' L .!- �:y,�� "L�, � <br /> State License# 5" Expiration Date: <br /> Phone: �5 6.�� 3s�-- 1�53 �-. (office) (cell) <br /> Mailing Address: �"'j y�T-,����,��; ,� 5 f ,,��;�/f Dly .�._� City: ZIP:.5'- 3 �� <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ;�����//� ��c�.�;`tG n <br /> Phone (day): � < � �- I yp <br /> Address: �/3 5 f�r l'c� Cit : ����(;� ZIP: 5 j.�S"� <br /> Email and/or Fax <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 /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> ❑ Sidin ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Re-roof ❑ Fire Damage www.minnehahacreek.orq � <br /> Overall Project Description: ; � y� � , �� <br /> Estimated Construction Valuation of Project excluding land) � ��p ,��,� � <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; ;fi <br /> ;� <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 information is to annually update our records and records of other governmental agencies � <br /> re uired b law. If ou refuse to su I t information, the a lication ma not be issued. <br /> . <br /> � <br /> ApplicanYs Signature: `� --� Date: � <br /> lU�,�� -�� � <br /> ,K <br /> Last Updated: 05-04-2009 � <br /> � <br /> � <br />