2015-00615 (window replacement) - Laserfiche WebLink

Home Browse Search

16122045430 ��a. - �L ��lJ _ • • City of Orono Building Permit Applicafiion for Maintenance / Replacement / Remodel C� (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSIQN) � � Z �O� MailingAddrass: Petmitnumber: ��J - �jJl O PO Box 66 Crystal Bay,MN 55323-0066 Date received: ��J'-1 J 5treetAddress� Received by: � � �, G� 275fl Kelley Parkway Plan review fee: ��KESN�� Orono,MN 55356 � ��`��'�� Total Fee; � Main: 952-249-46D0 Fax: 952-249-4b16 www.ci.orono.mn.us Thls application form must be completed in full and all required information must be submitted. �� v� e- Incomplete applications will be returned. (Please print) ,� GENERAL INFORMATI�N: ( Job Site Address: a�-�-(oq Car rn Q� 5`�.r�e�, �r0 n Will this be a Parade of Homes,Remodelers Showcase Home or other Dis ay Home? Yes �No Jf yes,a special event permit is required with Polrce pepartment and City Councrl approva!60 days priar to the event. Shutt/e 6us service will be required unless epplicant demonstrates su�cient an-site parkinq is availab/e. Non-permitted events will not be alfowed. CpNTRACTOR 1 APPLICANT INFORMATiON: Name: �p�,h,��}- V1n0.�.! k— State License# -- Explration Date: Lead Certification Number: - Expiration Date: (tor work on homes that were constructed prlor to 1978 Phone: (cell) �$Z- - $ (office) 6 l o��2A4-SS 7 9 � r��„y�y+�Q Mailing Address: �.}� C r �,.� S{.Y, City: brpho ZIP: S 3 Contact Person: 5��2 Applicant is: Contractor / omeowne �cir�ia o�o� Email and/or Fax: � ��. y,��(��'��r�• �..� PROPERTY OWNER INFORMATION: Name: �ur�rt�� ' �(1yL�- �0.�.i �G.. Phone(day): �o�a-ao�4- s�L��- - �a� !. Address: Sa�� a.S �.Mpo�.2. City: ZIP: Email and/or Fax: �"� PROJECT INFORMATION: Overall roectdescri tion: �4C-Q (o t,�►r.c�eWS-56u� 0.t�G�+ �Q�S'� 5��5 Type of ProJect: Any earth movement may also require MCWR revlew& ermits: ❑Qoor(s) ❑Remodel ❑Fire Damage P ❑Re-roof,asphalt ❑Repair ❑5torm Damage Minnehaha Creek Watershed DisUict(MCWD) ❑Re-roof,cedar 18202 Mfnnetonka 81vd ❑Restoration ❑Water Damage Qeephaven,MN 55391 ❑Re-roof,other(speclfy) ❑Slding ❑Other.{speciFy) Phone: 952-471-0590 Fax: 952-471-0682 �Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all informaGon required or requested hy the Buildfng Department; • Certifies that the information supplied is true and correct to the besl of hislher knowledge. The applicant recognizes thal lhey are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but lo reject Il until it fs complste; • Some or all of the Information that you are asked to provide on this application (s classified by 5tate 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 whlch generally cannot be glven to elther the public or the subject of the data, Our purpose and intended use of this information is to annually updale our records and records of other govemmental agencles required by law. IF ou refuse to su I the In ormatlon,th a Ilcatlom m �ot be lssued. Applicant's Signature: Date: J� �� J Owner's Signature: Y �'�-� aate: 5��`� IS Last Updated:January 2015