Laserfiche WebLink
Apr291108:57a TRADITION INC. 6514934527 p.2 <br /> 4 � � <br /> �It Of 0�'0�10 �I � <br /> � <br /> Bu�lding Perrnit Application fior Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address_ �O//—D v� 5. <br /> �'�y�0.� PO Box 66 Permit nvmber. _ <br /> (i � ,�� ��` CrysEal Bay, MN 55323-0066 Date received: <br /> a, �, ;� �.I' St�eet Address� Received by: <br /> \��r ' G��"� 2750 Kelley Parkway Plan review fee: <br /> �'Esxo¢� Orona, MN 55356 <br /> \ � �13.� 7 � <br /> Main: 952-249-4600 Fax: 952-249�616 www.ci:orono.mn us T°tal Fee: , S <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications wilf be returned. (Please prrnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� �MQ-n �- �r Q�p�a , �Yl rlJ. S"5� �j t <br /> Wil!this be a Parade of Homes, Rernodelers Shawcase Horne or other Display Home? ❑ Yes ❑ Nv <br /> if yes,a special event permit is required with Po/ic�e Oepartmenf and Ci(y Counci!approva/60 days prior to the event. Siruttle bus service will be <br /> requir�d unless applican!demonstra(es suffrcient on-site parkirn,�is auaiJab/e. 1Vort-pem�itted events will notbe allowed. <br /> COiVTRAGTOR!APPLICANT INFORMATION: <br /> �lame: Q A A�-r1v�J IQo�rrFi K 4 ne� �.Cferio/s Z�C• <br /> Sfate License# aob`3�b�7 Expiration Date: � _�/_Zo�3 <br /> Lead Certification Number: /V/q-T Z�I Zl� ► Expiration Date: � - za _Za�5 <br /> (for work on homes that were constructed�Orior io 1978 <br /> Ph�ne: (ocS!-(�98-3D2� (office) �ST� (p/2 •��b�c�y.3 (cell) <br /> Mailing Address: /p ��(� �jp S. C�ty: ZIP: <br /> Contact Person: �� ���o� Applicant is: ontractor 1 Homeowner (Circle One) <br /> Emai!and/or Fax: � �ad��to� �Oo,�n4 [�Dy� (�3"/- �S-3Oz� <br /> � <br /> PROPERTY OWfVER INFORMATIQN: <br /> Name: V��',.� �l,�.��►7�n <br /> Phone(day}: q$a.tl7/- 9�3a N <br /> Address: City Z�P_ <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of ProjecE: i Any earth movement may require <br /> ❑Door(s) ❑ Remodel ❑Water Damage MCWD r+eview 8�perrnits: <br /> ❑Window s Minnehaha Creek Watershed District(MCV11D) <br /> ( ) ❑ Repair ❑Storm Damage 182Q2 Minnetonka 6ivd <br /> ❑Siding ❑ Restoration ❑Other: {specifyj Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Re-roof ❑ Fire Damage <br /> Fax: 952-47i-0682 <br /> ww�v.minnehahacreek orq <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) $ (p�!- <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 tl�at they <br /> are solefy respons�ble for s�bmitling a compJete application being aware that upon failure to do so,the staff has no altemative <br /> but to reject it untif it is complete; <br /> • Some or all of the informafian that you are asked to provide on this apAlication is Gassified by State law as either private or <br /> confidential. Private data is information which generally cannot be gfven to #he pubfic but can be given to the subject of the <br /> daEa. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> plirpose and intended use of this inFormatio� is to annually update our rer,ords and reoords of other governmenta! agencies <br /> re uired b law. If ou refuse to s ! the information, e a lication ma not be issued. <br /> ApplicanE's Signature: � Qj��� <br /> Date: <br /> �as1 Updated: 03-Qi-?011 <br />