2014-01018 - roofing - Laserfiche WebLink

Home Browse Search

Sep 10 14 10:01 a All Around 18004198422 p.1 r- • • � �P�O �Jv�`�'��-�-(' ' City of Qrona Building Permit Applfcation for Mainfienance J Replacement I Renavation (No structural expansion. Only windows, doors, s'rding, re-roof, etc. /��A,O Iv1arlrng Address ! ! �p� `V PO Box 66 I Permit number: O � � Crystal Bay,lv1N 55323-0066 Date received: � � � Sfreet Add�ess: Received by: � �,� G. 2750 Kelley Parkway Plan review fee: ��k��'��00.� Orono,MN SS356 Main: 952-249-46�0 Fax: 952-249-4616 i:wv�v.ci.ororo-mn.us Total Fee: � /�,5� ►'r This apphcatron form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please printJ GENERAL ENFORr1ItATION: � Job Site Address: ; �j ;!'��,� ,�i'�_�� , , f�� .�� r Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [Q No lf yes,a special event permi;is required with Police Departme,�t and City Councr/approva!60 days prior tc th,e event Shuf1le bus ser6ice wr!!be requir�d unless apphcanf demor,strates suiRcient on-site parking is available. Non-perm;tied events wifl nof be allowea. CONTRACTOR!APPLICANT INF�RMATI�N; Na me: �L<_ �kv�.��., 1� �'��r-;�..�, ,�-- -- 2�.�.o+J;d.-� ,�y.�� State License# ` F�z � Expira#ion Date: Lead CertificatFon humber: / �-r f /� -� 3 , 'S �2��r, - ,. Expiration pate: .?2� /J�— (for work on homes that were consfructed prior to 1978 ' Phone: (cell} {_ _Z;e� �l f (office) �,tf.vt3 Mailing Address: -%LO ,� ' Z� � T-__�_�EC1r. �2 ;�-fc �•% City:,C Fti•�!'rc;i��ZIP: S S�?� Contact Person: �_5�� S�„�t rl-1 Applicant is��Co_e_ ntrac_pl�f' Hom�owner (CircJe One) Email and/or�ax ��5� �, - �. . � PROPERTY OWNER INFORMATI�N: Name: �'�F Pl.l E,.: �N�E'�cr-� Phone(day): ,��z _ c�/ Jt� � Address: ;'�C� �hFP�ri (';��FC �7:� Cit c c-� F Y� �i4�/Z{k!!;L- ZIP: �S3 : � EmaAand,'orFax: ��1�_��n.�E (ow� ' PROJECT If�FORMATION: Overall ro�ect descri tion: 7ype of Project: � Anyearth movement may also require ❑ Door{s) ❑ Remodel ❑Fire Damage �CwD review 8 permits: ��Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek UVatershed District(MCWD) � Re-roo`,cedar ❑ Restoration r I 18202 Minnetonka Blvd ❑Wate, Damage Deephaven, MN 55391 ❑ Re-roof,other(specify) ❑Siding ❑ Qther:(specify} I Phone: 952-471-Q59� � Fax: 952-471-0682 ❑Window(s) �tiv��.minnehahar_ree�ora Estimated Construction Valuation of Project(excluding land) $��; � APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all info�mation required or�equested by the Building Department; • Certifies that the inforrr�ation supptied is true and correct to the best of his;her kno��riledge. T�e applicant recogn�zes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; • Some or all of the inEorrnation that you are asked to provide on this application is classified by State law as either private or confidential. Privale data is information wnich generally cannot be given to the public but can be given to the subject of the data. i Confidential data is inf�rmaiion wfiich genera�y cannot be given t�either the public or the subject of the data. Our purpose and , intended use of this information is to annually,(pdate our records and records of other governmental agencies required by�aw. If ou r2fuse to su I the in ation,the�a lication maV not be Issued. Applicant'sSignature: __ --/s��---� pate: � � f� N �� � . � Owner's Signature: i` Date: Last Updated:03'o612013