2013-00819 (minor alterations-roofing)

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Aug 20 13 07:14a p.1 . �. Ci#y af Orono Building Permit ApAlicatian for Maintenance I Replacement / Renavation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �Q�O Mailing Addr�ss: P2rmit number: 20/3—� �/� PO Box 66 � Crystal Bay, MN 55323-0066 Date rece�ved: �'�l3 �a ,� Street Address: Received by� ti� G� 2750 Kelley Parkway Plan review fee: `q'�fSfi�¢� Orono, MN 55356 Main: 952-249-4600 Fax: 982-249-4616 �nn,vwci.orono,mn.us Total Fee: �1' 9p� ,� This application form must be completed in full and al!required information must be submitted. fncompfete applications will be returned. (Please prrntJ � GENERAL INFQRMATtON: Job Site Address: __ ��d�{ �f�� „�lj,� Will this be a Parade of Homes, Ftemodeiers Showcase Home or other Display Home? Yes lfyes, a special evenf permrtis required with Po/ice Departmenf and City CourtrJl approval 60 days pnor to(fie event. Shuttle bus service wifl be required unless applicant demonshates sufficienton-ste parking rs avaiJable. Non-permitfed events v�ill not6e allowed. C�NT{ZACTOR!APPLICANT INFORMATION: Name: �� �.o --�s StateLicense# t � : � 9 ��--� Expiration Date: 3�3(—�`� Lead Certification Number: Expiration Date: (for wor►t on homes that were constructed prior to 9978 Phone: (cell} '7��- 7 s� -a n G� {o�ce) `�E �--�s-�.-cso G G Mailing Address: l Y�'�Y ��,�c., r�. ,,,i�-..�. City: , ..,�la� c�-- ZIP: 5�'30 Gontact Person: ��,�,.,,. �,� Applicant is: Contractor Homeowner (Cirde One) Emai!andlorFax: �6� _�s--7 � �y_�J � , � k_ �� E G s �-�c �.�-iQ c c �,�.� PROPERTY OWNER INFORMATION: Name: �c�..� .S'� C .�,�G,/� �-. Phone (day}: �S a _ y?r- �i r--�� Address: 3 ��y C�s c� /��'!' City� �.-. � � ZfP Email andlor Fax: • 5� S�'�!� PROJECT INFORMATION; Overall ro�ect descri tion: /�� £'�� S•-�til� 5 �� s', Type of Project: ny earth movement may also require 0 Door(s} ❑Remodel MCWD review& ❑ Fire Damage permits: e-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed bistrict(MCWD) ❑ Re-roof, cedar ❑ Restoration 18202 Rrtinnetonka Blvd ❑Water Damage Deephaven, MN 55391 ❑ Re�-roof,other(specify} ❑Sidfng ❑Other (specify) Phone 952�71-0590 ❑Window(s) Fax: 952-471-0682 wwwminnehahacreek orq Estimated Construction Valuation o#Project(excluding land) g 3��n ._ � APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Departmertt; • CertiFies that the information supplied is true and correct to the best of his/her knowJedge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Sorne or all of the information that you are asked to provide on this application is cfassified by State law as either private or confidential. Private data is informatian which generally cannot be given#o the pubGc but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Qur purpose and intended use of this informat'on is to arnually update our records and records of other governmental agencies requrred by law. If o�; refuse to su I the information the a li ation ma not be issued. Applicant's Signature: ��1` Date: �--- /Y --/� Owner's Signature� Date: