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2011 - 01163 - roofing
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1214 Wildhurst Tr - 07-117-23-31-0036
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2011 - 01163 - roofing
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Last modified
8/22/2023 5:34:42 PM
Creation date
2/7/2020 1:11:32 PM
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x Address Old
House Number
1214
Street Name
Wildhurst
Street Type
Trail
Address
1214 Wildhurst Tr
Document Type
Permits/Inspections
PIN
0711723310036
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Sep 30 11 11,4:21a Schenkel 9524701781 p.2 <br /> City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number. /- <br /> �,0, PO Box 66 <br /> O O Crystal Bay, MN 55323-0066 Date received: �j.3D <br /> Received by: <br /> ,� ,�, ' ,, Street Address: <br /> , z /(//L <br /> , `i( *� '` Gti�' 2750 Kelley Parkway <br /> Plan review fee: <br /> 444.8s730$4' Orono, MN 55356 <br /> Total Fee: / .7_S- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.rnn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete application will be returned. (Please print) <br /> GENERAL INFORMATION: - _ <br /> Job Site Address: <br /> / <br /> ) o.S ) ) <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ 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 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> • <br /> CONTRACTOR l APPLICANT INFORMATION: <br /> Name: �nc )i n� ,-tin ' ( SSS _ C <br /> State License# o,c ,i 93 J Expiration Date: J3 <br /> Lead Certification Number: AI A41- 0'6/yQ-1 Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: /la 7/-7d(S" (office) (cell) <br /> Mailing Address: oZts'> g City: S d ZIP: "AA/_1333/ <br /> Contact Person: Q,lj Applicant is: Co tractor I Homeowner (circle One) <br /> Email and/or Fax 02- 1/76 - /7e1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: r� J LI�,-L C-)OS-2- <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 /> ❑ <br /> MCWD review&permits: <br /> Door(s) Remodel Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair E Storm Damage 18202 Minnetonka Blvd <br /> 0 Siding ❑ Restoration ElOther: (specify) Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> `) Re-roof 0 Fire Damage Fax: 952-471-0682 <br /> www.minnehahacreek.or4 <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) $ / 60 C> <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 int ation is o annually pdate our records and records of other governmental agencies <br /> required by law_ If you refuse to sup the info ation,thea plication ay not be issued. <br /> Applicant's Signature: \ Date: <br /> Last uodated: 03-01-2011 <br />
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