Laserfiche WebLink
Dec-09-2010 01:59pe From-CITY OF ORONO +9522494616 T-669 P.002/003 F-160 <br /> Building Permit Application-for Internal Work <br /> I <br /> windows, doors, siding, re-roof, etc.) <br /> MelNe <br /> PO BoxPam*number <br /> D/O <br /> PO Box 98e <br /> Q Crystal Say,MN 55323-0096 Date received: /d I <br /> r Sheat Address Received by: , <br /> 2750 Kelley Parkway Plan review tee: <br /> Orono, MN 55358 <br /> Main: 952-24S-4800 Fax, 952-248819 <br /> Total Fee: e oZ�• 1.3 <br /> This application form must be completed in full and all required inforrnetion must be submitted. <br /> GENERAL INFORMATION: Incomplete appikations will be ratumed. (urease print) <br /> Job Site Address: <br /> Will this be a Parade of Hornets, Remodelers Showcase Home or other Display Home? Yee No <br /> NY"i+ arm spsda/amientpsr»mit k ro�rhed with Polios Deparb»ent enol City Cexale//egarew/QO days pilot Oe tr+e swShUW6 bus xvn** N be <br /> ftWuNm►d up*"appricOnt dirmondietes suA C'"t on-el►s P"09 is aveula". Non-psrmifted awMa WX not be arorwd <br /> CONTRACTOR/APPLICANT INFORMATION; <br /> Name: Renewal By Andersen <br /> State License 0 1920 Count Road"C" West Expiration bate: <br /> Phone: Y <br /> Mailing Address: Roseville,MN 55113 cell <br /> Contact Parson: License#20130983 — City; <br /> it is; / owner ictrois one) <br /> Erman and/or Fax: 651-264-4777 Contractor Home <br /> PROPERTY OWNIE F RIMA <br /> Name; <br /> Eta <br /> Phone(day): - <br /> Email and/or Fax <br /> City: ZIP: <br /> PROJECT INFORMATION: <br /> Type of Project. Any earth move mo ay quip <br /> ❑Door(s) ❑ RemodelMCWD review&permits <br /> O Water Damage J <br /> C3Wlndow(s) Repair Minneheha Crack Watched District(MCV <br /> ❑storm Damage 18202 Minnetonka Blvd i <br /> ❑Siding ❑Rastoratkxm Deephaven,MN 55391 <br /> ❑Other:(specify) Phare: -471-0600 <br /> ❑Re-roof [)Fire Damage Fax, 852 71-06M2 <br /> M, Mek.ora <br /> _Overall Project Description: ' <br /> Estimated Construction Valuation of Pr0GCt excluding WWI 8 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; I <br /> • Certifies that the Information supplied Is true and correct to the best of his/her knowledge_ 'The appilcant recagnixes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to d0 so, the staff has no sitemalive <br /> but to rejed It until It is compieta; <br /> • Sorne or all of the infommetion that you are asked to provide on this apdication is classified t7y State law as either private or <br /> confidential. Private data Is information which generally cannot be given to the public but,oen Cs elven to the subject Ot the <br /> data. Confidential data is Information which generally cannot be Oven to either the public; or the subject d►the data. Our <br /> Purpose and intended use of this information is to annually update our records and records, of other govern'reqental agencies <br /> aired by low, If you refuse to 84DO&the Infflrmatloajoallication may not be issued. <br /> Applicant's Signature: Date: <br /> Last updated: o6-04-2009 <br /> 6 'd 08 !3- 09199 30IAN31S lIWH3d a R S P bZ ;CT 0703 a 000 <br />