2015-01578 interior remodel - Laserfiche WebLink

Home Browse Search

City of Orono Building Permit Application for Maintenance / Replacement / Remodel (i.�. �-- NO � �— Mailing Address: �� '��., PO Box 66 Permit number: �� S' 0��7 i� � \ Crystal Bay, MN 55323-0066 Date received: ��—/ ��l ) Street Address: Received by: /n 5� �/ 2750 Kell Parkwa — _ eY Y Plan review fee: � t, - `�� `�% Orono, MN 55356 \ �KftiHl�� -f� �QL__S7 1 Main: 952-249-4600 Fax: 952-249-4616 www.ci orono mn.us � « �� This application form must be completed in full and all required information mus be submitted. Incomplete applications will be returned. (Please print) $ew�` ¢ �'� ��J!%�93 GENERAL INFORMATION: �s� �y,�y�l� �"�U Job Site Address: ZOI� ScJhA{ZwC�OD �ZaV� �R�NO SS35lo Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes QNo If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �,—� ►�TL£M�1�I CoN ST1ZV G�I1oN State License# g��35989 Expiration Date: � ,3� . �pl�- Lead Certification Number: N�/� Expiration Date: N�,� (for work on homes that were constructed prior to 1978 Phone: (cell) �,p�2, qt,o3, plo-13 (office) �152 , 5�.} , CvgZ,lo Mailing Address: �gt7l P�MER.�CAN gl.v E ST�. 2l City: t3UOt�M�t�e(TD1J ZIP: 55y25 Contact Person: SAR�H I..+EVFl55 EVR Applicant is: Contractor / Homeowner �c�.�ie o�e� Email and/or Fax: S1evG15SGur� qj-}-E�C v'r0.Yl. COY►� PROPERTY OWNER INFORMATION: Name: K►NLBG-1�.�.�I MG�ttRES}tE1Z Phone (day): tv12, SOa. �i►°{O Address: 2,p�0 SV�aAi�WOOD �RIV�, City: O(LDt�fD ZIP: 5535(c Email and/or Fax: �G�Yv1tSh� 0.01� �Yn Stct AttAut�D PROJECT INFORMATION: Overall pro�ect description: MAST"'EIZ F3AT3tit.OpM R.E-M.oDE�- " St.oP� Type of Project: Any earth movement may also require ❑ Door(s) L�rcemodel ❑ Fire Damage MCWD review&permits: ❑ Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek orq Estimated Construction Valuation of Project(excluding land) $ i � APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If ou refuse to su I the informatio ,the a lication ma not be issued. ApplicanYs Signature: Date: �2• ��'• 15 Owner's Signatur�'� -------------- Date: l�� /(f Last Upda d:January,2015 �- G '7��/�/� �s�p��' � G'�`� `'� � `