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2011 - 01411 - siding
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Wolverton Place
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4575 Wolverton Pl - 31-118-23-31-0007
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2011 - 01411 - siding
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Last modified
8/22/2023 4:30:36 PM
Creation date
2/24/2020 9:21:55 AM
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x Address Old
House Number
4575
Street Name
Wolverton
Street Type
Place
Address
4575 Wolverton Place
Document Type
Permits/Inspections
PIN
3111823310007
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,.... City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: 070 //-(�/ V//` <br /> PO Box 66 <br /> (-----c,-,,04 <br /> Crystal Bay, MN 55323-0066 '`Date received: /l. 7/ <br /> ,, <br /> b Received by: <br /> A ;rte a, Street Address: <br /> t4 '‘A'I`.' �� 2750 Kelley Parkway <br /> t �, ,��, Y Y Plan 7:7fee:- <br /> -c <br /> 9kESHo4� Orono, MN 55356 <br /> Total // 'cam.435 <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 INFORMATION: <br /> Job Site Address: <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 /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: 41346-- 6i—oe i7-uJ,t.) 6IZOU/-7 . /Lie_ <br /> State License# 20637, 3a Expiration Date: <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: [._, l a _ a s'0 - L. `60-1 (office) (cell) <br /> Mailing Address: 1'7 3i(., i„seC—N I ' ) — /U City: 4 e—v L_C-- ZIP - j Z! L <br /> Contact Person: -DprKj Applicant is: C.- rac • / Homeowner (Circle One) <br /> Email and/or Fax: '�Rti ARL ve -rat?.1'+Tx:orlc.,0Dc>p. ( (r.ti-- <br /> PROPERTY OWNER INFORMATION: <br /> Name: EC-3C-Ct., - 1Oliit)`C 1 <br /> Phone (day): <br /> Address: -- ---- 1 )L , -_,'l' City: , ZIP: 5� <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ❑ Door(s) ❑ Remodel E Fire Damage MCWD review&permits: <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> E Re-roof, other(specify) ❑J iding ❑ Other: (specify) Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.orq <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) $ 000 <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: Date: ii - `a` /1 <br /> Last Updated: 08-09-2011 / <br />
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