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Jan 27 16 12:49p Craftmasters Remodeling 6517574106 p.2 <br /> City of Orono <br /> Building Permit AppEication for Maintenance 1 RepEacement/ Remodel — Residential ONLY <br /> , __ ___ <br /> :�. <br /> �_." • � ��Maifing Address: _.- � �� � � � �Permit number:�� . `��� � <br /> ��1�j .. PO Box 66 <br /> � �. Crystal Bay, MN 55323-0066 Date recaived: / - Z 7 —� �o <br /> , <br /> l � `i Received by: <br /> ` Streef Address� <br /> \ i ;: 2750 Kelley Parkway Plan review fee: <br /> �'` �E �', Orono,MN 5535fi �f � <br /> �;`��e�t',� Total Fee: c.�- � <br /> �.��M"�v1ain: 952-249-G606 Fax: 952-249-4"016 :�.���t�:�i.��'�t'������u� C <br /> This applicatlon form must be cornpleted in full and all required informatian must be submitied_ <br /> Incomptete applicaFions wifl be returned. {Please prrnf) <br /> GENERAL INFORMATION: '��)� y� � <br /> Job Site Address: t ���' � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> Ifyes,a specral eveni permif is requ.�red wi[h Police Cepa,dment and City Council approvai 60 day�s prior�o the event ShuKie tius servrce wr�l be <br /> required unless applicant demonst�ates suHicienf on-site pa,king is availabfe. Non-permittea events wi�l not be a1loNed. <br /> CONl"RACTO�t! PPLICAN+ T I�IFORMATION, ` <br /> Name: �`��L�-�-�f's>-f-i��v2`7 ��.:1_�.C�L.L��-�7�-_ <br /> State License# j (y,(� � Expiration Date: �- �i y <br /> c� � Expiration Date: � � ZE <br /> LeadCertificatlon Number: - 2,�`l� ` <br /> (for work on hames fhat were consfructed prior to 19T8 _,.--� <br /> Pnone: (cell) (office) �"�71 -��.�'7��--�--4 �.il.i' <br /> Nlailing Address: � °�� Y� �.L�� :C� . City: , �.�,`�ZIP: -��-f�j`� <br /> Contact Person: � j'�r�� Applicant is: �ontract,/or I Homeowner �c���ie or,e� <br /> EmailandlorFax: ��c-:..-�---�-r�.t` S�� 'L vi���� �C?,:�. - � . �.C;1Y`1 �e��ji�57��C'-'�i� <br /> PROPERTY OWNEF2 INFORMATI�N: <br /> � ,,�„ . <br /> Name: ��� �1'7 '� � `;4-- <br /> Phone (day): � <br /> Address: j�`�I�'"� City: ZIP: <br /> Ernaii andlor Fax: <br /> ��(��v�.?1 �' �Y1S���'?`-31 ���1 Z��-�-s�� <br /> PROJECT INFORMATI�N: Overall project description; � qny earth movement may also require <br /> Type of Project: I�ICWD review 8�perrnits: <br /> ❑ Door(s) ❑Remodel ❑Fire Damage <br /> Minne4�aha Creek Watershed Dlstrict;fv1CWD) <br /> ❑ Re-roof,asphalt ❑ Rep2ir ❑Storm Damage 15320 Wlinnetonka B':vd <br /> ❑Re-roof,cedar ❑ Restorafion ❑Water Damage Minnetonka, fv1N 55345 <br /> Phone: 952-471-459D <br /> ❑ Re-roof,other(speciiy) [� Siding �.ther:�speclfy) , Fax: 952-471-0682 I� <br /> �� ❑Window(s) �I��l� ���� vrv«,n31nnE�; s ����F:c;:_K�:.� � <br /> ' Estimated Construction Valuation of Project (excluding land) � �' <br /> APPLICANT ACKNOWL.EDGEMENT: <br /> . Agrees to provide all informatlon required or requestec by the Building Department; <br /> • Certifies that the lnformation supplied is true and correct to the besi of hislher knowledge. The applicant recognizes that they are <br /> solely responslble for submitting a complete application being aware ihat upon faifure to do so,the staff has no altemalive but to <br /> rejeci it until it is complete; <br /> • Sorne or a�l of the is�foRnation that you are asked to provide on this application '�s classified oy State law as either private or <br /> confidentiaL Private d2ta is'mformation which generally cannot be given to the p�blic but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to e�ther the public or the subject o#the data. Our purpos� and <br /> intended use of this information is :o annually update our records and records of other governmental agendes required by law. If j <br /> o�refuse to s� informaiion ihe a li lion ma�not be issued. � <br /> �-{ � �,, Z.� J�n ���- � � <br /> Appllcant's 5ignature's. I ,��'``'` Date: <br /> Owner's Signature' Date: <br /> Lasc Updated:January�201 � //�{qs �/n <br /> G� �.���� �X ��� <br />