2016-01283 - windows - Laserfiche WebLink

Home Browse Search

ct. 10. 2016 12:26PM No. 3099 P. 1 City of Orono Building Permit Application for Maintenance/Replacement/ Remodel—) ientla.�;FQN "Y (i.e. windows, doors, siding, re-roof, etc.—NO STRUCTURAL EXPANSION) Martin Address: Q PO Box 66 MN 55323-0066 `Date ;1iVeiit jj;''' __ ►?r;,l.l :'r1r;' ;- Crystal Bay, .. . ...,C�.. ...: _ ... .,.,.._...:•.:......-- Ftec�iva�py:._ Street Address: A2750 Kelley _ Orono MN 55356 E" Q - N - etital'�se�''� - - T _ : � R` Main: 952-249A600 Fax 952-249 4616 www.ci, rano.mn.us -=.�:s,:;:;;=�: = This application form must be completed in full and all required information must be submitted. Incomplete t) ,applications will be returned. (Please print) GENERAL INFORMATION:1 3„19 11) e Job Site Address: Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑Yes No if yes,a special event permit Is required with Police Department and City Coundl approval 60 days prior to the event. Shuffle bus service wiz!be required unless applk'snt demonstrates suftient on-+fe parking is available. Avon-permitted events will not be al/owed. CONTRACTOR/APPLICANT INFORMATION: Name: onhipr State License# Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1976 Phone: (cell) (office) a Mailing Address: City: Contact Person: Applicant is: I Horricowner—pircitonelf Email and/or Fax: �r PROPERTY OWNER INFORMA ION: C �” C•b Name: �'i► Phone(day): Address: City,6an () ZIP: 55 3 T Email and/or Fax: PROJECT INFORMATION: Overall project description, Type of Project: Any earth movement may also require ❑Door(s) El Remodel ❑Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) [IRe roof,asphalt ❑Repair El Storm Damage 15320 Minnetonka Blvd ❑Re-roof,cedar ❑Restorallon ❑Water Damage Minnetonka,MN 55345 ❑Re-roof,other(specify) ❑ iding ❑Other(specify) Phone: 952-471.0590 Fax: 952-471-0682 indow(s) nehahscreek.oLg Estimated Construction Vi6luation of Project(excluding land) $ 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 his/her 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; • 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 data. 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 you refuse to su t the information the application may notbeIssued. Applicant's Signature: Date: Owner's Signature: Date: Last Updaled:January 2016