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May 04 i0 02:53p C�ty Cons�rudion (952}934-0099 p2 <br /> C�ty of Orono <br /> Bu�lding Permit App�ication for Internal Work <br /> (windows, doors, siding, re�roof, etc,} <br /> j��:-��' - - Muiling Address' � Permit numbcr; �ld— <br /> 4.��� Po Ciox 86 <br /> ,�Q � � Crystal[3ay, MN 55323-OOGf Dalc rpceived: � ` <br /> (� ��i�, �A� a� Strcc!Add�ess� Received by: • _ <br /> `��, "'�'� ��� 2750 Kelley Parkway Plan review fee; <br /> ,.,:r���otti`�% Orono, MN 55358 � <br /> Total Fee� � �� , �j <br /> __ Main: �J52-249-4600 Fax: 952-2d9�616 vwvw.ci,orono.mn.us <br /> 7his application�form must be completed in full and alI required informa3ion must be subrrtitted_ '� <br /> Incompl�te applications will bo returned. (Plcase prinlJ <br /> GENERAL INFORMA710N: <br /> Job Site Addre55: 135 Chevy Chase Drive <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes x No <br /> If yos,a special avonl pormir is requr'red with Poli�Dopan.ment a�+d Gry Council�ppro��i e0 deys p�ior�a the even:. SII utile bus SOiv;CEi wil!be <br /> reQuiretl un�ess applicont demonst�ates sullicient on•sit�paiw'rig;e AvaifaDla lupn-permitfed evenfs wi71��ot be a�lov�ed. <br /> CON7}2ACTOR I APPLICANT INFORMA710N: <br /> Name; Caty Construction and Remadeling <br /> State License# BC•20431519 Expiration Oate: 0313112Q�,2 <br /> Phone: f952) 934_7�00 office} (612) 599,6387 Cell <br /> Mailing Address' 5716 Glen Ave City: Minn@tonka ZIP: �D34� <br /> Contact Person; Pat Coty Applicant is;QContraclor ! Womeowne� �c�rcb o�o�� <br /> Email 3nd/or Fax: pat(a�cotyconstruction.com__�952 834-0099 <br /> PROPER7Y OWNER INFORMA710N: <br /> Name: Robort and Sondra <br /> Phone (day); (952 473�323 � �� '�-' - <br /> AddresS; 135 ChevV Chase Drive City: Orono ZIP; 55391 <br /> Email and/or Fax howex0, O1(u�umn.edu ���� � � ` <br /> PROJECT lNFORAlIA7101�; <br /> I Typo of Project: "" ' --� <br /> Any carth movement rnay rQquire <br /> ❑ Door(s) (�Remodel hQCwD revlew 8 permltx <br /> ❑Water Damage <br /> Minnehaha Creek Watorshed Districl(MCIrVD) <br /> ❑WindoW;s) � Repair ❑Storm Damage 19202 Minnctonka Blvd <br /> Dcephaven, M�! 5G391 <br /> 0 Siding � Restoration �Other: s ecif <br /> f P Y� Phone; 952-47'-0590 <br /> _� Re-roof � Fax� 952-471-0662 <br /> ❑Fire Damage www.minn�hahacreP"K.ora <br /> Overall PraJect Descriptian: Tear-off!Reroof � '� � <br /> _Estimated Construction Valuation of Project(ex�luding land) S 9324,00 <br /> APPucqNT acKNaw�Eo�EMENT: <br /> - Agrees to provide all informalion required or requesteci by the Building Department; � <br /> ► CeRifies that Ihe in(orma6an supplicd is ttue and corr�ecl 10 the best of his/her know.edge_ The applicant recognizes that they <br /> are salely responsible for submilting a complote appJicatipn being aware that upan failure to d0 so, the slaff has na 3lternative <br /> b�t to rejoct it until IS is complete; <br /> • Some or all of the information thal you are asked t❑ provide on Ihis appliC3lion is classified by Stale law as eithor private or <br /> confidenlial. private dat� is iniormation which eenPrally cannot bo given to �he pub�i� but can kae given lo Ihp sub�ect of the <br /> I data. Confidential data is intormation which generally canc�px�be g�ven to ei�her the publie cr the subjec; of the data. 0��� <br /> purpose and intentled use of Ihis informali y is an � �/update our rar.ords and records of athcr govemmenta! �yenaes <br /> re ua ired,b law. If you refuse to Su�iply the i o ' n a lication may not bo is5ued. <br /> , � -� y <br /> Applicant's Signature: _/� Date; 0 510 4/2 0 1 0 <br /> rt•�— <br /> Last Updaled� 05-Od-200J <br />