2012-00481 - windows - Laserfiche WebLink

Home Browse Search

May, 31, 2012 12:29PM R. A, UNGERMAN CONST, 6128752901 No. 7116 P, 2 ��v 5,3� � � City of Orono Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc. Mailing Address' Pertnit number. 010 Ic��D � O.¢�,�0 PO Box 66 Crystal Bay,MN 55323-0066 �ate reoeived: -�J�- a-- � h,, Street Address: Reoeived by: S 2750 Kelley P�rkway Plan review fee: . �� $�� Orono, MN 55356 � �� ?� Total Fee: Main: 852-248�600 Fax: 952-248�616 www.ci.orono.mn.us This applicatlon form must be completed in full and all required information must be submitted. Incotnplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: J Will this be a Parade of Nomes�Remodelers Showcase Home or other Dlsplay Home? ❑Yes No ff yes,a speaal.sv+ent permit is required►�th Police Oepa�tment and G�ty Council approva160 days prior fo the event Shuftle bus se�vloa wlq De ___.. required unless applicant demonahafes sufiraent on-site parking la available. Non-permitfed ev�ents will not be albwed. �BN��B�f RP�LIeaa�F IN�O�IUIaTI�N: Name: � E� � State Ucense# �, �Z3 q �P��a �e= d 3/ Lead Celtificstion Number: _J�/,��S 3�../ Expiration Date: 07 ro�'�2e�S� (fip�wo►k on homes that were con cAed r!a to 19y8 Phone: � (office) _p� (cell) Mailing Address: � � y City: G ZIP: l/ Contact Person: Applica�t is: nti'dC / Homeowner �ciRio on•� Email and/or Fax: t�o,�.��.. � ��,�1�.,[� _ PROP.ERTY OWNER I ORMATION: Name: �rG�,Gg � �,4�,'� P.��Q��t'o�� Phone(day): �{��_ ac(C�_ � Address; !� ��, Cit�r: QL.c.-a ZIP: ,�',�� Email 8nd/or Fax PROJECT INFORMATfON: � Type of ProJect: Any earth movement may requlre ❑Door(s) ❑ Remodel ❑Fire Damage MCWD review&pertnits: Minnehaha Creek Watershed Distrid(MGWD) �Re-roof,asphalt �Repair ❑Storm Damege 18202 Minnetonka Bivd ❑Ra-roof,cedar ❑Restoration ❑Water Damage Deeph�ven,MN 55391 Phone: 952-479-0590 ❑Re-roof,other(epocly) ❑Siding ❑Other,(specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.ora Overall Pro'ect Descriptlon� �x. �� w�. S-�u,�co �+— S r!/i' � � �d� Estimated Constructlon Valuation of Pro'ect excludln land $ APPLICANT ACKNOWLEDGEMENT: , S0� od0 • qqrees to provide sll inFormation required or requested by the euilding Department; • Certifies that the inforrnafion supplied is true and correcl lo the best of his/her knowledge. The applicar�recogn¢es that they ere solely responsible br submitting a complete application being aware thai upon failure lo do so,the steff has no altemative but to reject It unlil it is oomplete; • Some or all of Ihe infortnation that you are asked to provide on this application is classified by State law as either privaie or confidenlial. Private data is information which eenerelly cannot be given to the public but can be given to the subject of the data- Confidential date is information which eraUy cannot be given b either the public or the subject of the data. Our purpose and intended use of this info n i o en ally update our records and records of other govemmental ag�ncles re uired b law. IF u reiuse to su th ' ati , a licatian ma not be issued. Applicant's Signature: �ete: � � ��