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04J02l2013 11:03 (.,�1�. `F�2" �� �A� P.001J001 <br /> � <br /> i City of �ro�na <br /> Buirding Permit Applicatiian for Maintenance I Replacement / Renovation <br /> (No structural �xpansion. Only windo�s, doors, siding, re-roof, etc.) <br /> �Ar Malling Address: Permit number: a0!3 -d Da!(. <br /> �V� Cryst�XBay,MN 55323-0066 Date roceived: 'Z��3 . <br /> Str�ef Address: Reoelved by: � S <br /> '� �' 2�50 lGelley Parlcway Pisn revlew fee: �--- <br /> y <br /> �t�� 8Hp�`�G drono,MN 55358 m <br /> ���Fea: 5l 5 �S� .-� 2 <br /> Msin: 952-249-4800 Fax: 952-249-4816 www.ci.orono,mn.� <br /> This applicatfon fo�m muat be campleted 1n full and aA requi�ed infarmatton must be submitted. <br /> Incamplete applications wtlt be retumed. (Please pNnt) <br /> G�N�RAL INFORMATION: <br /> Job Site Address: 2855 Somerset Lane, �rono,MN 55356 <br /> WIII this be a Parade oi Homes.Remodelers Showcase Home or ather Display Home7 Yes No <br /> !f yea,e epeda�event psnntt fe naquired wiN1 PoflCe Oepartment and Cily Councr!Approva!80 deys priorto H+e av8nt. ShufHs bus service wil!be <br /> rsqWred unlesa applicant damOnstretss su/Raent on-site parhing(s avaUable. IYorn pem►iffad events wlll not 6e allowed, <br /> CONTRACTOR I APPLICANT INFORMATlON: <br /> Name: Y.indus Construct�on�Inc.-Amy]ilk <br /> State Licenae# A(^007644 Expiration Date: 03�31/14 _ <br /> Lead Certification Number: NAT-58924-1 Expiration bate: 06/IO/15 <br /> (for work on homes ther wsro conatructed prlor io 197'8 <br /> Phone� (celi) (��) 715-684-4647 <br /> Mailing Address� 8�9 H 63 �� B dwin.WI ZIP: 54002 <br /> Contact F'erson: �,m � Appllcant Is Contrector Homeowner �a�aono> <br /> �maii and/o�Fax: <br /> PR�PERTY OWNER INFORMATION: <br /> Name: Jay&Laureen Kernan <br /> Ph�ne(day): 952-473-0026 <br /> Address: 2855 omerset ne C�tY� Oronoz MN Z�P� 5535�_ <br /> Email and/or Fax: ��� <br /> i <br /> PROJECT INFaRMATION: Overall ro ect descri tion: '� � <br /> Type of Projec� Any h movement m also require <br /> ❑poor(s) ❑Remodel ❑Fire Damage �NCWb review�permlts: � <br /> � Re-roof,asphelt ❑Rep�ir ❑Storm b�mege Minnehaha Creek Watershed District(MCWD)� � <br /> 18202 Minnetonka Btvd . <br /> 0 Re-raof,cedar ❑Restaratian ❑Water DamaBe Deephaven,MN 55381 , <br /> ❑Re-roof,other(epecify) ❑Siding ❑Other.(apedfy) Phone: 852-47'1-0590 <br /> Fax: 952�71-0fiS2 <br /> ❑Win ow( } www.minnehahecreak.ora <br /> �stimated Cons ru on alu8tion of P eGt(excluding latld) $ 32.900,,, <br /> APPLICAN1'ACKNOWLEDC�IVI�N7: <br /> . Agrees to provlde ail information required or roquested hy the Building Departmerrt; <br /> • Certifies that the informetlon eupplled is tru�and correCt to thm best ot his/her knowledge. The applicent recognizes lhat they ere <br /> solely reaponsibie for submitting a complete application being aware that upon fallure to do so,the staff has no alternative but to <br /> reject k until it is wmplete; <br /> • Some or all of the informatfon that yau are asked to provlde on this applicadon Is classified by Stete Iaw aa either private or <br /> confldenUal. Private data is informeHon which generally cannot be given to the public bul can be gNQn ro the aubjact of the dats. <br /> ConfideMial data is Information which gene Ily cannot be given to either the public or the sub]ed of the data. Our purpose and <br /> Intended uss of this' o atfon is to a ua y up te r reccrds and recorde of other govemmental agencies required by law. If <br /> ou refuse to su I e i rmetion a lic�ti not be-ssued. <br /> Applicar�t's Signature: p�e: 4/2/13 <br /> Qwner's Slgnature: Date: <br /> Laat Updeted;03106rz073 <br />