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City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: „_„7��3_�Q 3 <br /> ��,0,�.� PO Box 66 Permit number: �.� <br /> /iQ � Q Crystal Bay, MN 55323-0066 Date received: —� <br /> i' a> <br /> � ,� ��? `" �., 1 Street Address: Received by: <br /> �' � - � �������� ti`� � 2750 Kelle Parkwa <br /> � ' o y Y Plan review fee: (✓p 7 �� <br /> �9kESIi04/ Orono, MN 55356 ��j— ? <br /> �� Total Fee: ��/`� �`�7 <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 Adaress: 145 Smi th Avenue <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 wrth Polrce Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Brennan Properties LLC <br /> State License# BC381410 Expiration Date: 03/31/2013 <br /> Lead Certification Number: NAT-119015-1 Expiration Date: 11/24/2016 <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: 612-616-4447 (office) (cell) <br /> Mailing Address: 15680 Fi sh Poi nt RD SE city: Pri or Lake z�P: 55372 <br /> contact Person: Joe Brennan Applicant is: Contractor / Homeowner (Circte One) <br /> Email and�or Fax: Joe. Brennan@mchsi . com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Lori Gherardi <br /> Phone (day): 612-670-4228 <br /> address: 2985 Watertown Road city: Orono ZIP: <br /> Email and/or Fax Lori Gherardi @yahoo. 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 ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> ❑ Re-roof,other(specify) ❑ Siding [� Other: (specify) Fax: 952-471-0682 <br /> ❑Window(s) deck www.minnehahacreek.orq <br /> Overall Project Description:45 X 10 deCk <br /> Estimated Construction Valuation of Project(excluding land) $ $4, 000 <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 classifed 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 the information,the a lication ma not be issued. <br /> ApplicanYs Signature: � �r�;�;,y;��y Date: 05-14-13 <br /> Last Updated: 08-09-2011 <br />