Laserfiche WebLink
AUCs-31-2010 17:07 From:Window World 6517700495 To:9522494616 Page:1/3 <br /> X \, <br /> City of Orono <br /> ' Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc. <br /> Mailing Address: Permit number. 019�/ - <br /> Og o,j�� Po Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> Sheat Address: Received by: <br /> 2750 Kelley Parkway Plan review feeZI <br /> og� Orono,MN 55356 <br /> ' <br /> Main: 952-249-46W Famc 952-249-4610 vh,%a.arono mn.ua Total Fes: <br /> This application form must be completed in full and all required infot ration must be submitted. <br /> Incomplete applications will be returned. (Pkww print) <br /> GENERAL INFORMATION: <br /> Job Site Addrms, 845 Willow Dr S <br /> Will this be a Parade of Homes, Remodelers Showcase Homme or other Display Home? 0 Yes No <br /> fryw a spec#W event permit is raptured wM Podoe Deparbpent and OW Cbund approval W*p pw b Bre event Sh&ft bus aerhioe wdr be <br /> ►equahid un s 4Pplicar►t sulricrant ai otm parrarng is av�labra NmVerrr*W ousels wff not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Names ProBuilt America <br /> State License# Expiration Date: <br /> Picone: 651-770-9315 (offiW) <br /> Mailing Address: 2211 I T ve J& Ci : N. Paul ZIP• 55109 <br /> C dad Person: Els Ltj.U.L Dadid: Applicant is: tractor / Homeowner prem ones <br /> Email and/or Fac eatherdow ndowworldtaa.corn-651-770-04 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Rob Williams <br /> Phone(day): <br /> Adder; same as site CRY: ZIP: <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project Any earth movement ntay require <br /> MM review It pOnrtits <br /> E]Doogs) [jRemodel C]Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> m Windows) ❑Repair ❑Storm Damage 18202 Minratonke Blvd <br /> Deephaven.MN 55391 <br /> ❑Siding ❑Restoration ❑Other:(specify) Phone: 952-171-0590 <br /> Farr. 952.471 <br /> ❑Re-roof ❑Fre Damage s wfninnehahaaree t.nro <br /> Overall ProjectDescriplon: Replacing 10 windows not chariging size <br /> Estimated Construction Valuation of Project(excluding Iand) i 4734 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees.to pravtde all Warnution required or requested by the Building.Departrneru; <br /> • Certifies that the information supplied is true and corned to the best of histher 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 ha no eltemative <br /> but to mjed 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 pdvata 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 ft public or the subject of the data. Our <br /> purpose and intended use of this IMhxmadbn is to annually update our records and records of other governmental agencies <br /> required by law. It You refuse to WPOV the WarnatioN lbs @Rphadim may not be issued. <br /> Applicant's Signature: a Date: 08/27/10 <br /> Last updated: 05.04-2000 <br />