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, -�` . � i35�"� <br /> City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: permit number. <br /> ¢�.� PO Box 66 <br /> 0 � Crystal Bay, MN 55323-0066 Date received: <br /> � Strest Address: Receiv$d by: <br /> �,ti`� 2750 Kelley Parkway Plan review fee: <br /> ���o�.�' 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 60 Smith Ave <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes x No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus seivice will be <br /> ►equired unless applkant demonstrates s�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Coty Construction 8 Remodeling LLC <br /> State License# gC-20431519 Expiration Date: 03/31/201�! <br /> Lead Certification Number. NAT-115952-1 Expiration Date: 08/29/2016 <br /> (for work on homes that were constructed prlor to 1978 <br /> Phone: 952-934-7600 (office) 612-599-8387 (cell) <br /> Mailing Address: 1001 6th Street S City: Hopkins ZIP: �asa:s <br /> Contact Person: Patrick Cotv Applicant is: �Contractor / Homeowner �ci.�i.oo•� <br /> Email and/or Fax: pat(a�cotyconstruction.com 952-934-0099 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Sue Johnson <br /> Phone(day): 612-910-4010 <br /> Address: 60 Smith Ave. City: Orono ZIP: 55391 <br /> Email and/or Fax susieblank3�mchsi.com <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ❑ Door(s) ❑Remodel ❑Fire Damage MCWD review&permits: <br /> Minnehaha Creek Watershed District(MCWD) <br /> � Re-roof,asphalt ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd <br /> ❑Re-roof,cedar Deephaven, MN 55391 <br /> ❑ Restoration ❑Water Damage Phone: 952-471-0590 <br /> ❑Re-roof,other(speciiy) ❑Siding ❑Other:(specify) Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.ora <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) a 8665.00 <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 ge erally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of thi ' orma to annually update our records and records of other governmental agencies <br /> re uired b law. tf ou refuse su I th a ication ma not be issued. <br /> ApplicanYs Signature: Date: 05/13/2014 <br /> Last Updated: OS-09-2011 <br />