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Jul ' 21 ' 2011 1 : 32PM AMEK CONSTRUCTION INC' No . 9306 P. 1 <br /> City of Orono � �5 <br /> Building Permit Application for Internal Work <br /> (windows, doors, sldin , re-roof, etc. <br /> MalOfp Address. ......:::•.�..;•.,;::::::•: :••':,,::{;.t,�.::;.. r.. ,�. . <br /> PO Boot 08 <br /> 0 0 Crystal Boy, MN 55323-0068 �'�. :+ e•�!�'��;`:�:!::::::"•::;: 's:•;;:"!:;•: `,;;•� <br /> Recetii ,' <br /> Street Addmn.' <br /> 2750 Kelley Pe i'r.::.:..,•.;.;.;:..;.;;.:•;;;:,.::,:. <br /> O" .. Y:a�f.�Fslt�Vlilee '� '�; :;:';;`.i "�•......:� :..:':`•'?�,'ii�:';'`.�!� <br /> Orono,MN 55356 :::;.',:.•,:;.;..•;.::;':.:::::::::::: ..' <br /> Fax952249. 616-24600Mein: 952www.d.nrono.mn.us :' <::•i,;';';:;:.::::!::.. . . :,•,:.:...,:... .. <br /> This application fwm must be completed in full and all required information must be submltled. <br /> GENERAL INFORMATION: <br /> Incompla*applkadons will be raWmed. (Please privet) <br /> � /�. � C� <br /> Job$11NAddress: �/ <br /> Oil this be a Parade of Hones,Reinode rs Showcase Noun or otlwr Display Home? LJ Yes M No <br /> Nyes,a Specter event pemrlt S►egrd W wi h Payce Deperhrwnt and CW OWndf appmvd W days pdorto tits event. Shuf v bus edN be <br /> ivgtdmd urden appboe►rt mates xddw*o►►-ate pwft is avauble. Non-peffyi ed everts wit not be aUorved. <br /> CONTRACTOR/AP UCANT INFO MA ION; <br /> Name: <br /> state Uosnse ZVI IP4 0Z Expiration Date: <br /> Lead Certification Number: ,- Expiration Dae: <br /> Ror ww*on homes Mw wero consfra W prior eo 1978 <br /> Phone: 9,05Z,ob (office) (cell) <br /> Mailing Address: CRY: ZIP: <br /> Contact Person: Applicant is: / '-Homeowner Icnsle ony <br /> Email and/or Fax: CYT2,. JO gtq <br /> PROPERTY OWNERpINRMIT10f <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP; <br /> Email and/or Fax <br /> PROJECT INFORMATION; <br /> Type of Project: Any earth movement may require <br /> ❑Door(e) ❑Remodel ❑Water Damage MCWD MVlew,3 permits: <br /> Mirmehahe Creek Watershed District(MCWD) <br /> ❑Window(s) ❑Repair ❑Storm Demage 18202 Minnetonka Blvd <br /> ❑Siding ❑Restoration ❑Other.(specify) Deephaven,MN 55361 <br /> Phone: 952.4714500 <br /> *6-roof ❑Fire Damm Fax: 952.471-0682 <br /> www.minn ah@grqek.orc <br /> Overall Project Desai <br /> Estimarbed Constriction Valuation of Pro" evtcludin lend) $ <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Budding 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 Stabs law as either private or <br /> confidential. Private data is information which generally cannot be given to the pubic 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 data. Our <br /> purpose and intended use of rion to wwwaily update our records and records of other governmental agencies <br /> re uired by Igft60ULfus9 the-abblication may rot be <br /> Applicant's Signeture: Dom: / <br /> Last Updated: 03.01-=1 <br />