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� l�'1� 7s • vo � City of Orono �� , � � Suilding Permit Application for Maint�nance / Replacement / Renova#ion � (No structural expansion. Only windows, doors, siding, re-roof, etc.) /�'O� Mailing Address: Permit number: � �I� � PO Box 66 Crystal Bay, MN 55323-0066 Date received: � Street Address: Received by: � \ ` 2750 Kelley Parkway Plan review fee: � �� Orono, MN 55356 ��tsEaoa Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 3335 Crystal Bay Rd, Orono, MN 55391 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes,a special event permit is required with Police Department and City C:ouncil approval 60 days prior to the event. Shuttle bus service will be ranuirP.ci un��ss aon�icant demanstrates sufficient on-si!e narking is availab/e. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Lindus Construction, Inc. State License# BC007644 Expiration Date: 3/31/16 Lead Certification Number. NA'I'-58924-1 Expiration Date: 6/10/15 (for work on homes that were constructed prior to 1978 Phone: (cell) (office) 651-967-0379 Mailing Address: g79 Hw 63 City: B win,WI Z�P� 54002 Contact Person: Amy Jilk Applicant is:;-�ontractor Homeowner (Circle One) Email and/or Fax: amyC�lindusco com C �— PROPERTY OWNER INFORMATION: Name: Paul Rehman Phone (day): 612.801.9057 Address: 3335 Crystal I�ay Rd City: Orono, MN ZIP: 55391 Email and/or Fax: PROJECT INFORMATION: Overall ro�ect descri tion: Reroofin - tear off existin and replace with new Type of Project: Any earth movement may also require ❑ Door(s) MCWD review&permits: ❑ Remodel ❑ Fire Damage �Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof, cedar LJ Restoration ❑ VVater Damage ueephaven, MN 55391 Phone: 952-471-0590 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ > APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that 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 alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information whicl� erally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is tA'ann Ily update our recer�a�d records of other governmental agencies required by law. If ou refuse to su I the informatio�,the lication a ot-be;'i s d. ApplicanYs Signature: Amy Jilk _ � Date: 10/9/14 Owner's Signature: �° Date: Last Updated:03/06/2013 V/ � �5