2014-00480 - bldg - door replacement

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City of Orono Building Permit Application for Maintenance / Renovation (Windows, doors, siding, re-roof, etc.) Mall/ngAddresi Permit number: 0201 �U O�a 0.1�� PO Box 66 Crystal Bay,MN 55323-0066 Date received: 5-20— / v3 a Street Address:. Received by: 2750 Kelley.Parkway Plan review fee: Orono, MN 55356 Main: 952-249-4600 Fax 952-249-"16 fatal Fee: 0107. 1-3 y85W.Ci.OrOno.mn.us This application form must be completed in full and all required information must be submitted. GENERAL INFORMATION; Incomplete applicdtions will be returned. (Please print) Job Site Address: a-+03 WoAk,(S -4434 Lav)�P_ Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No Ifyes,a special event permit Is raquired with Police Department and City Council approval 60 days prior to the event. Shuffle bus service will be required unless applicant demonstrates sufficient on-site parking is avallable. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name. State License# 'BC,X W S 3 Expiration Date: 'S Lead Certification Number: Expiration Date: (for work on homes that were constructed odor to 1978 Phone: (051- a - (office) (cell) Mailing Address' p ��G WEA City. ZIP :11e - 551)32 , Contact Person: Applicant is: Lcon"etar / Homeowner (circie or*) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: 15 11%_I_e e��-, Phone(day): 29-a Address: City; ZIP: Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑Door(s) ❑ Remodel ❑Fire Damage MCWD review&permits- ❑ Re-roof,asphalt El Repair El Creek Watershed District(MCWD) R ❑Storm Damage 18202 Minnetonka Blvd El Re-roof,cedar ❑ Restoration ©Water barrage Deephaven, MN 55391 Phone: 952-471-0590 ❑Re-roof,other(specify) ❑Sidi 11 Other: (s cify) Fax, 952-471-0682 Vla))v`'w aCa t Po c � www.minnehahacreek.vrg Overall Project Descriion: E=stimated Construction Valuation of Project(excluding land) $ � r 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[Mly the information,thea lication may not be issued. ADDficant's Sionature: �-� Date: