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� Ci of orono �3379 � �uilding Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) Mailing Address: Permit number. �3—�.7 �-�� PO Box 66 Crystal Bay, MN 55323-0066 Date receiv�: —�� Streef Address: ��by� S�, ,��:" 2750 Kelley Parkway Plan review f�: ��. � t,��s��,�' Orono,MN 55356 �Q/3��„ .� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: 2380 Abingdon Way, Orono, MN 55356 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes �No lf yes,a specia/event permit is required with Police DepartmeM and City Council approva/60 days prior to the event Shuttle bus senrice will be required unless applicant demonst►ates suffi'cient on-site parking is available. Non permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Cobblestone Homes Inc. (Erik Olsen) State License# BC468842 Expiration Date: 3-31-14 Lead Certification Number: QB132528 Built in 1985 Expiration Date: 2-3-17 (for work on homes that were constructed prlor to 9978 Phone: (cell) 952-292-3081 (office) 952-473-3520 Mailing Address: 1161 Wa zata Blvd. E #308 C�Y� Wa zata Z�P� 55391 Contact Person: Erik Olsen Applicant is: ontracto / Homeowner �ci�io o�o� Email and/or Fax: �(�cshbuilder.com PROPERTY OWNER INFORMATION: Name: Scott and Elizabeth Monico Phone(day): 612-963-8228 Address: 2380 Abingdon Way City: Long Lake ZIP: 55356 Email and/or Fax: Replace some windows and patio doors. Raise grea.t room floor up. PROJECT INFORMATION: Overall ro'ect description: Re-trim interior and paint. Add laundry room in the basement. Type of Project: Any earth movement may also require �Door(s) �Remodel ❑ Fire Damage MCWD review&permits: ❑Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 ❑Re-roof,other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 �Window(s) wuvw.minnehahacreek.ora Estimated Construction Valuation of Project(excluding land) $ 18,578.00 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Departrnent; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other govemmental agencies required by law. If ou refuse to su I ths info ation,the 'cation ma not be issued. Applicant's Signature: Date: S��2 v�� Owner's Signature: Date: S'��- /3 Last Updated:03/06/2013