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City of Orono <br /> Building Permit Application <br /> Mailing Address: Permit number: <br /> �,�,�. PO Box 66 <br /> 0 ��, � <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ��` Received by: <br /> a r �. Street Address: <br /> �' �� ti�' 2750 Kelle Parkwa <br /> � � Y Y Plan review fee: <br /> l<YgE$HD¢� Orono, MN 55356 <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: <br /> Job Site Address: 2447 Carman St.,Orono 55391 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ✓ No <br /> /f yes,a specia!event permit is required with Po/ice Department and City Counci/approva/60 days prior to the event. Shutt/e bus service wi//be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events wil/not 6e allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Owner-Joseph P. Bluth <br /> State License# N/A Expiration Date: <br /> Phone: (507)625-6986 (offce) (cell) <br /> Mailing Address: 2201 W. Dream Drive, City: North Mankato ZIP: 56003 <br /> Contact Person: Joseph Bluth(or son,Tony 50/381-2089) Applicant is: Contractor / Homeowner (Circte One) <br /> Email and/or Fax: josephbluth(c�hotmail.com(fax 507-387-2111) <br /> PROPERTY OWNER INFORMATION: <br /> Name: Joseph P. Bluth/JoAnn M. Bluth <br /> Phone(day): (507)625-6986 <br /> Address: 2201 W. Dream Drive, City: North Mankato Z�p: 56003 <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review 8�permits <br /> 0 Door(s) �Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> 0 Window(s) �Repair ❑Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> �Siding 8 Restoration �Other: (specify) Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> 8 Re-roof ❑Fire Damage garage/basement wallp www.minnehahacreek.orQ <br /> Overall Project Description: <br /> Estimated Cons ruction Va atio of Project(excluding land) $ 35,000.00 <br /> . �APPLICANT CKNOWLEDGEMEN�~ � �� � <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 altemative <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 govemmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> Applicant's Signature: Date: ��08/09 <br /> Reset Form <br />