2014-01352 (Re-roof) - Laserfiche WebLink

Home Browse Search

r , City of Orono Building Permit Applica#ion for Maintenance / Replacement / Renovation �No structural expansion. Only windows, doors, siding, re-roof, etc.� �O�O Mailing Address: Permit number: — 5 PO Box 66 Crystal Bay, M N 55323-0066 Date received: ///�'—/ Street Address: Received by: � y � 2750 Keliey Parkway Plan review fee: `�! L Orono,MN 55356 Rk�s�� TotalFee: a/�. �.5 Main: 952-249-4600 Fax: 952-249-4616 www.ci,orona.mn.us This application farrn must be completed in full and ali required information must be submitted. (ncomplete applications wiii be returned. {Ptease print) GENERAL INFORMATfON: t r ��,�� Job Site Address: ,�j 7� �ofi�(,�4�Y ��t,�K �U• O�$i'�O , �A� Will this be a Parade af Homea, Remodelers Showcase Narne or other Display Home7 Yes �f+lc K yes,a speclal event permit is required with PWrce Department anri City Councit approvai 6Q days prior to fhs event. 5huttfe bus servlce wili be required unJess app/icant demonstretes sut�rcient onsite parking is availa6ls. Non-pem'iltted avents w!!1 not be ellowed. CONTRACTOR 1 APPLiCAnN�T INFORMATI(}N: ./� Name: /T il�7"Kv LFjh(�'y'u+�P�h.. State License# �C j,(,3 b�, Expiration Date: 3 3�� S" Lead Certification fVvmber: p'T .- b��$ � ! Expiration Date: 7��!d S {far work on homes that were canstructed prior to i978 Phone: (celi) "��1 (office) 763— ��f " S 53t7 Mailing Address: � k�r,;� �, c. /b 3 C�tY� /hcc � Pla�'•• ZIP: �"�y�j Contact Person: �y� oy�„ Applicant is: ontractor Homeowner (CircleOna) Email and/or Fax: �,�J a f l s�.v 4(Q"y , {t►i.+►, PROPERTY OWNER INFORMATION: Name: 7;P�,. �- G��ra"S �b�n,�on Phone(day): q s Z - 2�!0 - 94 p p Add�ess: 1376 'Ra l�1�� &�� Rd- c�ty: �jro�.,v ziP: 55 39/ Email andlor Fax: ��r►S 1o�►R3�v� `�/A� � ��+�' •tQ� PROJECT INFORMATIQN: Overall ro'ect descri tion: Type of Projeat: My earth movement may also require � ❑ Door{s) ❑Remodel ❑ Fire damage ��Wg��`��' �{Re-roof,asphalt ❑Repair ❑Storrn Damage Minnehaha Creek Wetershed Qistr3ct(MCWD) 18202 Minnetonka Blvd ❑Re-roof,cedar ❑Restaration ❑Water Damage Deephaven,MN 55391 ❑Re-roof,other(specity) ❑Siding ❑�ther:(specify) Phone: 952-471-0590 Fax: 952-471-D682 ❑Window{s) www.minnehahacresk.orq _J Estimated Constructlan Valuation of Project(excludtng land} � . a0 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all informatian required or requested by the Building Department; • Gertifies that the information supplied is Uue and correct to the best of his/her knowiedge. The applicant recognizes that they are soiely responsible far submitting a complete applica6on being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; I • Some or all of ihe inforrnation that you are asked to provide on this application is classified by State law as either privake or confidential. Private data is information which generalty cannot be given to the public but can be given to the subject of the data. Confidential data �s infor+nation which generatly cannot be given to either the public or the subject of the data. Our purpose and intended use of this!nformation is to annua update our records and records of other governmental agencies required by law. If ou refuse to su 1 khe in ation,th cation ma not be issued. Applicant's Signature: Date: �{ �°{' � Owner's Signature: Date: Last Updated:03/06/2013