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City of Orono 5Ay <br /> Building Permit Application ivq, 2S <br /> Mailing Address: permit number: 2009-00 Z.03 <br /> .¢,O� Cr Box 66 C I <br /> O Crystal Bay, MN 55323-0066 Date received: ) ( OCI s <br /> }�' Received by: V Q I lJ 0 <br /> ,-1, 1CC� , ti Street Address: ; I 2eX q u ozoz 1 �9 <br /> ,t, I;04'1 G~ 2750 Kelley Parkway PA. W/ V ,cp--- Plan review fee: i I `[ <br /> lyxEsxog• <br /> �i Orono, MN 55356 Z) <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) .J <br /> GENERAL INFORMATION: <br /> Job Site Address: 835 WINDJAMMER LANE ORONO, MN 55364 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑✓ Yes ❑ No LA <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. V <br /> CONTRACTOR/APPLICANT INFORMATION: S <br /> Name: T J B REMODELING AND DESIGN INC -v) <br /> State License# BC-20396490 Expiration Date: 03/31/10 <br /> Phone: (763)780-2944 (office) (763)286-4299 (cell) <br /> Mailing Address: 9100 BALTIMORE ST NE City: BLAINE. MN ZIP: 55449 S <br /> Contact Person: RICK BUDZYNSKI Applicant is: <Contractoj / Homeowner (Circle One) n <br /> Email and/or Fax: RICKTJBHOMES.COM 763-767-1372 1T <br /> PROPERTY OWNER INFORMATION: <br /> Name: SCOTT AND JEN HANSON -kr) <br /> Phone (day): (952)567-0601 s <br /> Address: 835 WINDJAMMER LANE City: ORONO, MN ZIP: 55364 6 <br /> 1 Email and/or Fax <br /> i PROJECT INFORMATION: ✓I <br /> I Type of Project: Any earth movement may require 4 <br /> MCWD review&permits 0 <br /> 0 Door(s) El Remodel 0 Water Damage v <br /> Minnehaha Creek Watershed District(MCWD) s <br /> D Window(s) 0 Repair ❑Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 0 <br /> 0 Siding IM Restoration ❑Other: (specify) Phone: 952-471-0590 V1 <br /> Fax: 952-471-0682 <br /> 8 Re-roof 0 Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: REMODEL ENTIRE INTERIOR OF HOUSE, NEW WINDOWS,SIDING, ROOFING <br /> Estimated Construction Valuation of Project(excluding land) $ 225,000.00 <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: • ., . ,.,,, 41$ Date: - Q <br /> 3a 9 <br /> Reset Farm <br />