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2014-01006 - windows
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Forest Lake Drive
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4250 Forest Lake Drive - 07-117-23-12-0022
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2014-01006 - windows
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Last modified
8/22/2023 5:30:40 PM
Creation date
8/12/2020 2:50:06 PM
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x Address Old
House Number
4250
Street Name
Forest Lake
Street Type
Drive
Address
4250 Forest Lake Dr
Document Type
Permits/Inspections
PIN
0711723120022
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. ` <br /> City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> ;;:¢,�,�:'\ PO Box 66 <br /> !-� �AV Crystal Bay, MN 55323-0066 Date received: <br /> i. <br /> ; I Received by: <br /> ��,� ,�� r�: �.;� StreetAddress: <br /> \�`�l ��'���'�����G//� Oro�no, MN 55356 aY Plan review fee: <br /> ��kEs H�4:� <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 INFORMATION:Y 2 �.O �O �.� ST <br /> Job Site Address: � !� �lL !�/�I1�C�, <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 wi/l be <br /> required unless applicant demonstrates su(ficient on-site parking is available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �1 S? 3�l j'. G t9y 7 <br /> State �icense# THD At- Home Service, Inc, � <br /> Phone: 2690 Cumberland Pkwy, Ste 300 (ce��) <br /> Mailing Address: Atlanta, GA 30339-3913 ZIP: <br /> Contact Person: Lic # CR268257 Ph. 763/542-8826 lomeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER FORMATI N: /� <br /> Name: � o b� /' /.�O /� � S��L <br /> Phone (day): 9 rs a y 7 ? • �Y� / 'I 0 U n � ZIP: s�3 � <br /> Address: � $ O O/'d � � Q � L D/�. Cit : <br /> Email and/or Fax <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: (,�� p� /` Q �'/ C) I n <br /> Estimated Construction Valuation of Project (exclu ing land) $ (a a O <br /> . <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 /> re uired b law. If ou refuse to suppl the information,the a lication ma not be issued. <br /> Applicant's Signature: ' � `�� Date: j [ � ` ! � <br /> Last Updated: 05-04-2009 <br />
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