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To: ' Pahl of 4 2013-11-00 02:14:32(GMT) 19528585081 From: Joo Brennan <br /> f <br /> City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit:number: ©� if <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 <br /> � y <br /> Al? Street Address: Fier eiued by: <br /> 2750 Kelley Parkway Plan review fee; <br /> �. <br /> Orono, MN 55356 <br /> Agog; <br /> -- Total Fee: <br /> Main: 952-2 -4600 Fax: 952-249-4616 www.ci.orono. n.us <br /> This applica 'on form must be completed in full and all re ired information must be submitted. <br /> Incomplete applications will be retu ned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 45 Togo Road <br /> Will <br /> tI K yes, a spece a ial event perme of it requi�Vvith Pollillers Showcase ice Department and City <br /> dome cirapproeva Display0 daypriori to the event. Shuttle bus service will be <br /> required unless applicant dentgnstrates sufficient on-site park' is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR TION: <br /> Name: Brennan Pro erti s 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 prio0 f 8 <br /> Phone: 612-616-4447 (office) (cell) <br /> Mailing Address: 15680 Fish Point city: Prior Lake ZIP: 55372 <br /> Contact Person: Joe Brennan Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: Joe.Brennan@MChs i com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Lori Gherardi <br /> Phone(day): 612-670-4228 <br /> Address: 2985 Watertow Road City: Orono ZIP: <br /> Email and/or Fax Lor i Ghera rd i ahoo.com <br /> PROJECT INFORMATION: _/ <br /> Type of Project: Any earth movement may require <br /> ❑Door(s) VRestoration <br /> odel ❑ Fire Damage MCWD review&permits: <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Re-roof,asphalt air ❑Storm Damage 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> ❑ Re-roof, other(specify) ng ❑Other: (specify) Fax: 952-471-0682 <br /> dow(s) <br /> vrww.m inn ehahacreek.ora <br /> Overall Project Descri tion:bath remodel; add upstairs bath re de I : ;expand bedroom <br /> Estimated Construct' n Valuation of Project(excluding land) p, D <br /> APPLICANT ACK LEDGEMENT: <br /> • Agrees to prode all information required or requested by the Building Department; <br /> • Certi that he 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 classified 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 /> required by law. If you refuse to supply the information,the application may not be issued. <br /> Applicant's Signature: Joe Brennan Date: 11-4-13 <br /> Last Updated: 08-09-2011 <br />