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Frdm:HUN�RBERG CONSTRUCTION 763 463 5046 07/20/2011 09 : 14 #456 P.001/001 City of Orono Building Permit Appfication for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: ' � ' O.��,�0 PO Box 66 Permit num6er: aC�E l—U Crystal Bay, MN 55323-0066 Date received: ZU . � � �-�r � StreetAddress: Received 6y: � ' 2750 Kelley Parkway Plan reviewfee. iqR��ogrv° Orono, MN 55356 � _ - Total Fee: /�`'` 4-�� Main; 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �..� This application form must be completed in full and alt required information must be submitted� !� ,55 Incomplete applications wifl be returned. (P/ease print) �� / 3 GENERAL INFORMATI�N: Job Site Addresa: �lao Cox f�rm cad Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No lf yes,a special evenf permit is required with Police Departmenf and City Council approva!60 days prior to the evenf. Shuffle bus service will be required unless applicant demonstrafes su�cient on�site parking is availab/e. Non-�ermitted events wlll not be allowed. CONTRACTOR 1 APPLICANT INFORMATION: Name: Hunerbcr� L'Qns�-rucf�on �om�3nu State License# 3ay� Expiration Date: c,�/,��/,�oi.�t, Lead Certification Number: Expiration Date: (foi work on homes that were constructed prfor to 1978 Phone, 74 3-H4�-SoH� (office) ��a-g�a-y s�L� (cell) MailingAddress: lll02 �� PruG IVor' City: a )c C-rcv� Z�P: 5�3L�) Contact Person: JeF� �hcv�n Applicant is: Contractor / Homeowner (CircleOna) Email and/or Fax: ;e�F� t' �un rh rn. ��rrt PROPERTY OWNER INFORMATION: Name: 1�l�ll�am L ��pCr Phone(day): Address: llaa L'cu farm Ruad City: �;ony ��1�� ZIP: 553.5� Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑Do�r(s) ❑ Remodel �Water Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑Window(s) � Repair ❑ Siorm Damage 18202 Minnetonka Blvd �Siding ❑Restoration ❑ Other:(specify) Deephaven, MN 55391 Phone: 952-1471-0590 ❑ Re-roof ❑Fire Damage Fax: 952-47�-0682 www.m i n n��ha�reek.orq Ove�all Project Description: a;cr Infr sion C a, s -�A I'ar a .5�ucao Estimated Construction Valuation of Project(exc uding land) $ � APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; . Certifies thai the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes 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 lnformation that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generelly cannot be glven to the public but can be given to the subject of the data. Confidential data is infvrmation which generally cannot be given to either the public or the suhject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies re uired b law. If ou refuse to su I the Information,th lication ma not be issued. Applicant's Signature: Date: �'J'�'�`— � l' Last Updated: 03-01-2011