Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> (3,4Crystal <br /> r Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Received by: <br /> A ,,a;:2 <br /> �, a Street Address: <br /> 1t ,, ;I" Gtiti 2750 Kelley Parkway <br /> Orono, MN 55356 Plan review fee: <br /> ',)' t• <br /> �AESH01. <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATIO • 7� ,�� <br /> Job Site Address: 700 (X-XS-4 B 2'l '1 0/6-no I'. l� _536-4/J <br /> Will this be a Parade of omes, Remodelers Showcase Home or other Display Home? C Yes ,No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: OLone/y-- <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION:W0/7 <br /> Name: M {�iV SOiv'. <br /> Phone (day): 5(9. 4{7,2 '7c_S j -' r <br /> Address: 4/700 GL�.e--� orcIA,,,,A, j- city:OrSi/1 c) ZI P:� (P <br /> Email and/or Fax c'Sc� 4/7.Q / 79/ <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review& permits <br /> ❑ Door(s) ❑ Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑ Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ',Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: e ;rQ <br /> Estimated Construction Valuation of Project(excluding land) $ _---- 9.00, fwd <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building 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 State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the information, the application may not be issued. <br /> Applicant's Signature: )------- -&-1 ._.-.---, _ Date: 9 -. ( C' - ( <br /> Last Updated: 05-04-2009 <br />