Laserfiche WebLink
Oct � 14 � 2010 10 � 05RM LEGRCY EXTERIORS 661 -430-3466 No , 8705 P , � <br /> .. . - . �;�/ � � <br /> Cit of Orono v _/ <br /> Y <br /> �uiiding Permit Application for �nternal Work <br /> windows, doors, slding, r�-roof, etc�) ��/����//A <br /> Mailina Aadress; ��,;�:;,; ::�;;�;,;,� ", / <br /> �0,� PO Box 66 Pe�mlt number , -- f.�" � /� /� <br /> , 1 ` , l`T•i"/' <br /> 0 � Crystal Bay, MN 55323-0066 �Dete.�oelVed; . .,, d <br /> Sheet Address: RQ�eiyed b�i , <br /> ��"� � 2750 Kelley Par�y Rlan��revlevy,�fe�;.,..;� <br /> '+�c a�� Orono, MN 86358 ��;: ' , , <br /> �, <br /> Total,F8s � ,. <br /> Main: 852-249-4600 Fax; 952-249-4616 www.ci.orono.mn,u�, ,. ���� �� <br /> , <br /> 7hls�pplication form must be completed In full and all requlred Information must be submltted, <br /> Incomplpte applicatlons wlll be returned. (Ple�Be pr'Int) <br /> (3ENERAL IN�ORMATION: � ��� <br /> Job Slte Address: � <br /> Will this be a Parade of Hvmes, Remodelers Showcase Home or other Dlsplay Home? Yes o <br /> If yos,a apsc191 avant permlf l�requlred with Pollce Department end City Counoll approvel QO deys prlor fa the evgnf. Shuftle bus servlce wlll be <br /> �equired unleas applloant demonatrafea sufflcl�nt an-alfa pa�kinp Is avellable. Non�pelmittad e►renta wlll nof be allowed, <br /> CONTRACTOR I AP�LICANT INFOR�IIA710N; <br /> Name; �L, e GL <br /> Stste License# Explre o . .�O/ <br /> Phone; �$ - - offl e �o - -p� � cell <br /> Meilina Address; 35a''� f ZIP: p <br /> Contact Person: ,OE Appllcant Is: on e / Momeowner �ciroi•o�a� <br /> Email end/or Fex: n <br /> PROPERTY OWNER INFORMATION� <br /> Name: ph p <br /> Phone(day): - �O <br /> Address: O CI : A ZIP: <br /> Emall and/or Fax <br /> PROJECT INFORMATION: <br /> Type oi Project; Any earth movement may requlro <br /> ❑ Door(s) ❑ Remodel MCWD revlew&permlts <br /> ❑Weter Demage <br /> Minnehaha Creek Watershed Dlstrlct(MCWD) <br /> ❑Wlndow(s) ❑ Repafr torm Damage 182�2 Minnetonka Hlvd <br /> Deephaven,MN 55391 <br /> ❑Slding []Restoretlon ❑ Other:(epecify) Phone: 852-471-0590 <br /> e-roof ❑Flre Damaoe Fax; 852-471-0682 <br /> www,minnehe.hecreek.arQ <br /> Overall Pro'ect Descrl lon; <br /> Estimated Constructlon Valuatlon of ProJect(excluding land) $ (,�jp�� <br /> APPLICANT ACKNOWLEDGEMENT; <br /> • Agrees to provlde all Informatlon required or requested by th�Buildin0 Department; <br /> • Certliles that th� informatlon supplled le true end Correct to the beet oi hls/h�r knowledge, The eppllcant recognizes th�t they <br /> ere sol�ly responsible for eubmltting � complete appllcatlon being aware th�t upon fallure to do so, the staff has no elternative <br /> but to reject it untll It 16 complete; <br /> • Some or ell of the informatlon thet you ere esked to provlde on thls eppllcation is clasBiFled by Stete lew as either p�ivate or <br /> oonflden6al, Private date I� Informetlon which generally cannot be glven to the publlc but cen be glven to the subJect of the <br /> d�ta. Confidentlal date le fniormation which Qenerally cannot be given to either the publlc or the subject of the dete. Our <br /> purpose and Intended uae of this informatlon le to ennually update our recorde end recorda of other�overnmentel egenciea <br /> re ulred b law. If ou refuse to su I the infnrmat�vn the a Ilcetlon ma not b�issued. <br /> Applicant's Slgnature: Date: <D � <br /> ��upda�ed: os-oa-zooe <br />