Laserfiche WebLink
City of Orono <br /> Building Permit Application for Maintenance 1 Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address. <br /> O PO Box 66 Permit number. — <br /> �I/ Crystal Bay, MN 55323-0066 Date received: <br /> Street Address_ Received by: <br /> 2750 Kelley Parkway <br /> � o Orono,MN 55356 Plan review fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 `roww.ci.orono.mn.us Total Fee: , <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. <br /> GENERAL INFORMATION: (Please print) <br /> Job Site Address: �j7 �!(' , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? L1 Yes <br /> ff yes,a special event permit is required VWth Police Department and City Council approval 60 days <br /> prior to the ettle bus <br /> required unless apprcant demonstrates sufficient on-site par ting is available_ Non-permed eventsvWiiHtnot be allowed.service will be <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: -.� •,, - <br /> State License# Expiration Date: <br /> Lead Certification Number. �� ... 7- % <br /> (for work on homes brat were constlruc pdor to 1978 Expiration Date: <br /> Phone: _ .- (office) _ <br /> - 26_s c. (cell) <br /> Mailing Address: � City: <br /> Contact Person: / ZIP: <br /> Email and/or Fax: - .. <br /> Applicant is: Contractor / Homeowner (Cirdeonei <br /> - 3 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: <br /> Email and/or Fax Cid ZIP: <br /> PROJECT INFORMATION: <br /> Type of Project: <br /> Any earth movement may require <br /> ❑Door(s) ❑Remodel Q Fire Damage MCWD review&permits: <br /> air Minnehaha Creek Watershed District(MCWD) <br /> ❑Re-roof,asphalt ❑ Re <br /> p Q Storm Damage 18202 Minnetonka Blvd <br /> e-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> ❑Re-roof,other(specity) ❑Siding ❑Other. (specify) Phone.9552 471-0 20 <br /> Fax:❑Window(s) www.minnehahacreek ora <br /> Overall Project Description: -- j -0 <br /> Estimated Construction Valuation of Project(excluding land) $ y <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the 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 /> re uired law. If ou refuse to supplythe inforrrail6h the application may not be issued. <br /> Applicant's Signature: p <br /> Last updated: Oe-OsL2ol I ate: Z/ <br />