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From:HUNERBERG CONSTR��ON 763 463 5046 06/08/2011 12:15 #431 P.001/001 . - �� C ity of O ro n o Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: ��—Q�� j�,�,�� PO Box 66 Permit number: �� Crystal Bay, MN 56323-0066 Date received: � / �; , Q ' a, ± �� a, I 5treet Address: Received by,- ` '�'(?y tif'J 2750 Kelle Parkwa �k� � Y Y Plan review fee: ly gsv Orono, MN 55356 (� �7 ESK� Total Fee: `�i ��_ / Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 7his application form must be completed in full and all requireci information must be submitted. (ncomplete applications wi(I be returned. (Please print) GENERAL INFORMATION: Job Site Address: '7� Cr s�al C'reel• c�d �� 3-Ils�-a3-33-oDo3 Will this be a Parade of Homes, Re odelers Showcase Home or other Display Home? Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shud/e bus service will be required un/ess applicant demonstra�es su�cient on-site perking is available. Non permilfed events will nof be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Hun�rbCr�i CcnStrucYJon L��mpanu State License# 3�2H3 Expiration Date: c,�/arJz��;z, Lead Ce�tification Number Expiration Date� (for work on homes fi►at we�e constructed prior to 1978 Phone: 7�,;�-H�,3-5��a (office) ��,2•Slz-9��D (cell) MailingAddress: ��cz yl�rh Rvz c Ncr C'tY= a IcGrcvc Z�P� 55345 Contact Person: JcfF cphvvFn Applicant is: Contractor• / Homeowner (CircleOne) Emailand/orFax: ,j�F-tv � hl�nerberu:c�vrn fvx` '763-y1,3-��tiia PROPERTY OWNER INFORMATION: Name: Q�u�ilas 3nd Jbann ��yno�d.s Phone(day): ,�t� - �,a'S�- �� L7 Address: '75 cr T�fai L'rzeh j�cad City: prv�o Z�P� �5354 Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review&permits: ❑Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWQ) ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd Deephaven, MN 55391 �Siding ❑ Restoration ❑ Other:(specify) Phone: 952-d71-0590 ❑ Re-roof ❑ Fire Damage Fax: 952-471-0682 www.mi nneh ahacreek.oro OverallProjectDescription: l{Cm�vc Sfuerc andir�5iaj1 ��s�d�n � �4 c:�` �,guf(" Estimated Construction Valuation of Project (excluding Isnd) $ <,/��;��.,� APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information requlred or requested by the Building Department; . Certifies that the information supplied is true and correct to tha best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware thaf 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 applicatlon is classifled by State law as either private or confidential. Pnvate data is information which generally cannot he given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject 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 e a lication ma not be issued. ApplicanYs Signature: Date: �� 1 Last Updated: 03-01-2011