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Nov., 04 X011 1:39PH Coty Constriction 9529340099 page 1 <br /> City of Orono <br /> Building Permit Application for Maintenance l Renovation <br /> (windows, doors, sidin .Ire-roof, etc. <br /> Malting.Address: -: <br /> PO Box t98 <br /> (� 0 Crystal Bay, MN 55323-M <br /> Sbeef Address: a <br /> 2750 Kelley Parkway <br /> 't -s: .yr ;�,:;. .,ti:: :'lls.�• <br /> Orono,MN 55356 ,x.. <br /> Main: 952-249-4800 Fax: 952-249-4616r <br /> �emoer.d.o ono.m .ua <br /> This application form must be completed In full and ail required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 420 Turnham Road <br /> Will this be a Parade of Homes, Remodelem Showcase Home or other Display Home? Yes 0 No <br /> ffyw a spade!event PWW Is m paired with Ponce Department and CRY COOW SARMW 00 days prior to Me event. shunts bus ser*@ WX be <br /> req~unless sppiicant dsmonatratsa suffidient on-&%pwkhp is&v&V k. Non_psrm ted events win not be Mowed. <br /> CONTRACTOR t APPLICANT INFORMATION: <br /> Name: Cott Construction&Remodeling LLC <br /> State License d 80.2043151» Expiration Date: 03/31/2012 <br /> Lead Certlfxmtion Number: NAT-115952-1 Expiration Date: 08/29/2016 <br /> (for work on homes forst were cons&ucftd prior to 1878 <br /> Phone: 9524034 7600 (office) 612-5994387 (cell) <br /> Mailing Address: 5716 Glen Ave City: Minnetonka ZIP: bomb <br /> Contact Person: Patrick Cotv Applicant is: ®Contractor / Homeowner lciroaoMl . <br /> Email and/or Fax: pat0cotvconstruction.com 952434-0099 <br /> PROPERTY OWNER INFORMATION: . <br /> Name: Lenny and Kathy Berg <br /> Phone(day): 952-5444468 <br /> Address: 420 Turnham Rd. COY: Orono ZIP: 55359 <br /> Email and/or Fax <br /> i <br /> PROJECT INFORMATION: . <br /> /yips of Project: Any earth movement may require <br /> O Door(s) ❑Remodel ❑Fire Damage IIACWD.review a permits: <br /> ®Re-roof,asphalt �p Minneheha Creek Watershed District(MCWD) <br /> ❑Storm Damage 18202 Minnetonka Blvd <br /> Q Re-roof,ceder ❑Restoration ❑Water Damage beephaven, MN 55391 <br /> Phase: 952.471-0590 <br /> ®Re-roof,other(spedryl [3 siding ❑Other.(specify) Fax 952-471-M <br /> Steel on shad 13 Windows) <br /> _Overall Project Description:Tear�off reroof on house—tear-off reroof,replace with similar steel rooflina on storage building <br /> Estimated Construction Valuation of Project(excluding land) $16,152.00 <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 <br /> are sole) responsible for submitting a complete 9e PP recopnno that they <br /> Y po 9 p application being aware that upon failure to do so, the staff has no sltematNe <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 date Is information which generally cannot be given to either the public or the subject of the date. Our <br /> purpose and Intended use of this informatio .Is to an update our records and records of other governmental.agencies <br /> required,b tow, ifyou refuse to s i e ilcation may not be issued. <br /> Applicant's Signature: /' ,.-" Date: 11/02/2011 <br />