2014-00556 - siding - Laserfiche WebLink

Home Browse Search

I '� �ity af �ra�o �uil ing P�rmit Application for Maintenance f Repla�err�ent / Ren�vation (N s�ructur�l gxpansion. c3n1y�in�ow�, �tc�or�, si�in�, re-r�c�f, e#c.) '" Mailing Address: Permit number. (9D� - D 55 '� ��- ` PO Box 66 Crystal Bay, MN 55323-0066 Date received: �p '3—� �` � � S�reef Address: Received by: Q�S • :� � � 2750 Kelley Park:n�ay Plan revi�w fee: \. f, " ' Orono, MN 55356 �_��x ��{,� :33�.G� _ Total F�e: in: 952-249-4600 Fax: 952-249-4616 is application form mast be completed in ful! and all required information must be submitted. lncomplete applications will be returned. (Please print) GENER L INFORMATIQN: Job Sit AddrSss: �� (,�Ss�� Will thi be a��arade of Homes, Remodelers Showcase Fiome ar other Display Home? ❑'Yes No Jfyes,a spec 1 event permi�is required w�h Po1re Departmenf ancl City Councit approvaJ 60 days prror to the event. Shutfle bus service wr11 be requrred unfess applicant demonstrafes sufficient on-sr�e parking is available. P+ton-permifted events will not he a/lowed. CONTR CTtJR /APPLICANT WFORMATION; Name: �fDNl,¢� !."3�� v�IrTi� ; !/�'C State Li ense# �'�� 2� �[�c� � Expiraiion Date: 3 --3� — /b Lead G rtifica i n Number: ��_ /�l �'�"j S_� Expiration Date: 2 .-2�_ �� (for rk o omes that were constructed prior to 197$ Phone: (cell) (F/� -7S`�- S�ol7� (office) �S 2- �7.5 fo 77 7 i111ailing ddre : � 3 � 2�T,9 �L�/d �s' City: L,q�,` ZIP: S3 Contact Pers Applicant is: rac / Hemeowner {Circle Dne) Emaif a dlor x: �6i^e.� � r�„z.w`ji'�H.- i��1'� c��• PR�?E TY OWNER INFORMATION: Name: ��,¢�Ll,C �F.iG[SS Phone ( ay): �olZ �32�—�.�:i0 Addres : I , Gity: ZIP: Email a dlor �ax: C�l��j2L�-S��SS � ��ffD� , Gefyt PROJ CT I FORMATION: Overall ro�ect descri tion: Type of roje k Any earth movement may�Iso require ❑ Door( ) ❑ Remodel ❑ Fire Damage MCWD review&permits: ❑ Re-r f, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCUVD) 182t72 Minnetonka Blvd ❑ Re-r f,ce� r ❑Restoration ❑VUater Qamage Deephaven, MN 55391 ❑ Re-r f,ot r(specif� �Siding ��ther. (specify} Phone: 952-471-0590 D ` Fax: 952-471-0682 _ �1/1/II1ddW(S) FlLr/jZl��✓�G(J �_n+�,ni�,n.��1i!l^Fr1:�3h�3i'raP,�( qr" Estima ed C struction Valuatian of Project (excluding land) $ 1�1'. APPLI AN CKNOWLEDGE�UIENT: . A rees t �provide all information required or requested ay the Building Department; • C rtifies at the information supplied is true and correct to th� best of histher kno;nrledge. The applicant recognizes that they are s ely re� onsible for suk,mitting a camplete application being aware that upon failure ta do so, the staff has no alternative but to rej ct it � til it is complete; • S me or a!I of the information that you are asked to provide on this application is classified by State faw as either private or � c fiden i 1. Private data is information U�hich generally cannot be given to the public but can be given to the sut�ject of tha data. C nfide�t�al data is information which genarally cannot be given to either the public or the subject of the data. Our purpose and in nded se of this information is to annually update our records and records af other governmental agencies required by law. If y refu to supply the information,the lication may not�e issued. Applica t's Si ature: �Jate: —� — Ov�mer' Sign� ure: �ate: Last Upd ed:03746/2013 I�