2011-01334 - windows - Laserfiche WebLink

Home Browse Search

10/26/2011 12:28 7637532505 STOP PAGE 02I03 , � City of Orono Building Permit Application for Maintenance / Renovation (windows, doors, �iding, re-roof, �tc.) g►�� Ma,II PO Box 66� Permit number: �//—b/ � Q Crystal Bay, MN 55323-0066 Date received: �� � Strset Addnsss: R�ceived by: � 2750 Kelley Parkwoy Plan review fee: �ag�� Orono, MN 55356 Total Fee: �3� � �f Maln; 952�249-4600 Fax: 952-249-4616 www,cl,orono.mn.us / '11ifs application form must be completed in full and ell required information must be submitted. Incomplete applications will be retumed. (Pl�ase prinl) G�N�RAL.INFORMATION: JobSlteAddress: Z� CoaCOR.A�A �t-R�F.G� QR.c�o Mt� 553`11 Will thi�be a Parede of Fiomes, Remodelers Showceae Homa or other Display Home? Yes No If y�ea,a spedel ev�ant permll is requlrvd wlfh Polfce Department end City Gbuncil apprvval 80 d�ys prlor to tha event. Shuttle bus serviae w�ll be required unlesx applicant demonstieles sufl7clent on,slta ps�lc�ng is aveilable, Nonyoermi'tbed av�nts wlll nct ba sllowed. CONTRACTOR/APPLICANT INFORMATION: Neme: 24 R-ES�o(� Srate Lic�nsa# ei,C 3o I 3�� Expiratlon Date: 03 3� 2A� Lead Certification Number. _NAT- 39 b1'i- � Expiration Date: 05�2.� z,,p� (tbr work on home�s d►at we►e construct�d prOor ro i978 Phone: 7 b 3-'�S 3- �O80 ---(of�ce) (cetl) Mailing Address: bb�5 141s�r p.V�NUE IJuJ ��tY= (2At�+StN ��P� SSbo� � Contact Person: �,pE, �.��W Applicant is; Contrackor / Homeowner �cn�►a o�.� �mafl and/or Fax: �� Z,r-{.fe�S-I��e_ ��m � PFtOP�R7Y OWNER INFORMATION: Name: ��g �I�p�p�T p��p �,.,�ND A M A�,o 51�y Phone(day): q5a-as o� �o�,�.,,�3 Address: ��-1 S 6 RA�-K�'� R-�oA�_ _ City: EXC.�I.S 10 F� ZIP: 5S 3 3 1 _ Email and/or Fax -}��S,��Qq,p��qr�..E. c�o�c�4e,S. C�orn PRO.l�CT INFORMATION: Type of ProJect: Any eaRh movem�nt mey r�qulre ❑Ooor(s) ❑Remodel �Fir�Damege MCWD review�permft�: Minnehaha Creek Watershed District(MCVW) ❑Re-roof,aspAalt ❑Repair ❑Storm Damage 182�2 Minnetonke Blvd ❑Re-roof, cedar �Restoratfon ❑Wate�Damage Deephaven, MN 55391 Phone: 952-471-0590 ❑Re-roof, other(epeclfy� �Siding ❑Other. (specify) Fax: 952-�471-0682 �.Window(s) ��jnnehahacreek,oro Overall proJectDescriptlon: Supp�EMEN�r -ro p�� o�S PER,t�� FDR W�N�owS S io�aG Fstlmated Con�tructlon Valuation of Pro�ect(excludMg_land) $ 25,p$►,� q APPLICANT ACKNOWL.EDGEMENT: . Agreea to provide ail information required or r�quesLed by the Building pepartmen� • CeRlfles that the information supplled Is true and correct to tho best of hle/her knowledge. The epplicant recognizes that they are solely reaponsible for submltting a complete application being aware that upon failure ta do so, the ataif has no�Itemative but to rej�ct it untll lt Is complele; • Svme or afl of the infa�nat�on that you are asked to provlde on this application is clasaifed by State law as elth�r private or oonfldential. Private data is fnform�tlon which generally cannot be glven to the public but can be given to the subject of the deta. Confidentfel data la Informa�tion which ganerally c�nnot be given to either the public or the subJ�c� af the data, Ou� purpoee �nd intended use of this infnrtnatlon is to ennually update our ►ecords and recorcJs of other governmQntal �genGes re ulred b law. If ou rafusa to au I the fnFoimation the a lication ma not be Issued. Appficant's Signature: �YU. ��,�, � Date: �U I2(�` I I Last Updated: 08-OB-2011