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T City of Orono Building Permit Application for Maintenance / Replacement/ Remodel - Residential ONLY (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) i Mailing Address: Permit number: PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: Received by: S2750 Kelley ParkwayPlan review fee: `� Orono, MN 55356 lHO�� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 3505 Watertown Rd, Orono Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes it No K yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available_ Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Kuhl's Contracting, Inc State License# BC195769 Expiration Date: 03/31/19 Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (office) 952.935.9469 Mailing Address: 1515 5th St S Suite K City:Hopkins ZIP: 55343 Contact Person: Brook Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: brook@kuhldesignbuild.com PROPERTY OWNER INFORMATION: Name: Gonzalo Petschen Phone(day): Address: 3505 Watertown Rd City: Orono ZIP: Email and/or Fax: PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: ,VRe-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.org Estimated Construction Valuation 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 info ab n that you are asked to provide on this application is classified by State law as either private or confidential. Private da is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is in mation which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this in rma W is to annually update our records and records of other governmental agencies required by law. If you refuse to supply t e i tion,thea lica ion may not be issued. 1 Applicant's Signature: Ll Date: I I I l Owner's Signature: Date: Last Updated:January 2016