2012-00656 - roofing - Laserfiche WebLink

Home Browse Search

Gln 49012 09:06 Les Jones Roofing,Inc. fA>q 0017009 P.0011001 City of Orono Building Permit Application for Maintenance / Renovation windows, doors, siding, re-roof, etc.) O MaiIiPO am eg Permit number o?0�4"' —0 �o Q Q Crystal Say,MN 55323-0088 Date received: 2-//-/2- Street Address: Received by: 2750 Kelley Parkway Plan review Orono,MN 55366 Main: 952-249-4500 Fax: 952-2494818 wv►w.a.orano.mn.us Total Fee: a This application form must be completed in full and all required Information must be submitted. Incomplete applications will be retumed. (Please pont) GENERAL INFORMATION: Job Site Address: R QAn Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes El No ff yes,a spscW event pent*Is mquksd wink P+oft Department and Cly Cum*aWrovel 80 deys pdar to Nis event. Shuttte bue aerWce w9/be required w*u eppNhent denw8beArs sdffdant on4b pwft Is ava9ebfe. NorpefmNed events w9l not be aNbwed CONTRACTOR I APPLICANT INFORMATION: Name: 3 State License# (e 560 _ Expiration Date: Lead Certification Number. NAZI 40312-1 Expiration Date: 5 Z !S (for work on homes that were constructed prior to 1978 Phone: 952- Sgl -11'2yl (office) qSA-16l-Atli Gr2—?37-i968(�19 Mailing Address: j ( W, zo MfibrF City: ZIP: Contact Person: Applicant is: (2!ptractor / Homeowner icnere one) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: 8 4&A0AA C-AdU<- Phone(day): Address: City: ZIP: Email and/or Fax PROJECT INFORMATION: Pe ofProject: Any earth movement may require ❑Door(s) ❑Remodel ❑Fire Damage MCWD review&permits: Minnehahe Creek Watershed District(MCWD) ❑Re-roof,asphalt ❑Repair Storm Damage 16202 Minnetonka Blvd* Re-roof,id,)rr(8P6cIfy) ❑Restoration �COI Water Damage Desphaven,MN 55391 Phone: 962-471.0590 Re-roof, ❑Siding 13 Other(specify) Fax: 952-471-0882 F.p PkWindow(s) www.minnehahacreek.oro Overall Project Description: Rr14y E*#j) AEAr. G C OA& Room 4UA EPDM EtAr RdoFS ftmp yr o Estimated Constructlon Valuation of Project(excluding land) $ Z,7 ,50 507, AVPc.ac6 SOMI Hnnrp, 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 hielher 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; e 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 date. 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-XLu refuse 12:9upply the information lication may not be Issued. Applicants Signature: Date: 7 /rLly i not i inrier.ot• nn.no.enl i