Laserfiche WebLink
, . . <br /> City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: �(, !�— �� <br /> �,�,�. PO Box 66 <br /> 0 �\ O Crystal Bay, MN 55323-0066 Date received: �U �-� <br /> a ����'�-��,'� a � Street Address: Received by: <br /> 4.,> <br /> �'.�, .��� oti 2750 Kelley Parkway Plan review fee: <br /> r`�kESHog,� 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: C��L� � ��T�C�� � � <br /> Will this be a Parade of Homes, emodelers Sh wcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service w�I be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC�NT INFQ RMA ON: �. �� J /',-� �; <br /> Name: _��►�F y����`-�C� �% 3 <br /> State License# (�5�J Expiration Date: <br /> Phone: — � office cell <br /> Mailing Address: - - Cit : ZIP: — <br /> Contact Person: ,�(� /3 Applicant is: tractor Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �`�,,(� /� <br /> Phone (day): <br /> Address: �. G�( � Cit : � 'y�'Q ZIP: � ( <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review 8�permits <br /> ❑ Door(s) ❑ Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 � <br /> ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Re-roof ❑ Fire Damage www.minnehahacreek.orp <br /> verall Project Description: -i �? <br /> Estimated Construction Valuation of Project(excluding land) $ �"' <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 that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> ' <br /> • Some or all of the information that ' '�re asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is infor tion which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is infor a ion ich generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of t is nfor ati n is to annuall date our records and records of other governmental agencies <br /> re uired b law. If ou refuse s I h info tion,t a lication ma not be issued. <br /> ApplicanYs Signature: Date: f � �� <br /> LastUpdated: 05-04-2009 <br />