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2009-00656 - roofing
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100 Crystal Creek Road - 33-118-23-33-0009
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2009-00656 - roofing
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Last modified
8/22/2023 4:50:12 PM
Creation date
6/6/2016 12:59:04 PM
Metadata
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x Address Old
House Number
100
Street Name
Crystal Creek
Street Type
Road
Address
100 Crystal Creek Road
Document Type
Permits/Inspections
PIN
3311823330009
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� <br /> • � � 111 <br /> ' City of Orono <br /> Building Permit Application <br /> �_—__� Mailing Address: oa�_� <br /> ��4.,O,j�. PO Box 66 Permit number: <br /> , � Crystal Bay, MN 55323-0066 Date received: U d/ O <br /> �����'"��� - Received by: <br /> a ; �' ��.;r:,. �. Street Address: <br /> �.�,L' '� '+�� �ti 2750 Kelley Parkway Plan review fee: <br /> 9kESH04� Orono, MN 55356 <br /> \ ' / � <br /> - Total Fee: / <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � 4�� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: a� C�,. St � C�`�.�r� ^ � /\o� , <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP�ICANT INFORMATION: <br /> Name: !�}VYIeV'�� C�v� ✓�u�'�c�c`r? COY1'}�a� taYS, Tti'lC . <br /> State License# C9 I b q 38� Expiration Date: ' i ' �) <br /> Phone: ,Z— p' _ office cell <br /> Mailing Address: b0 d�Zc� ,:ti- �1 Ci � y,j/� ZIP: <br /> Contact Person: �l� � - Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATI N: <br /> Name: /�'�Q r h� �!,(.� f�2 j/l//�./1 i✓l g`�i`"L- <br /> Phone (day): 6t�— QN5- a9 �s J <br /> Address: %Oa �'x s,�Q l L' re ei� i�o( - city: OroMc� ziP: S.5 35,6 <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review&permits <br /> ❑ Door(s) � Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> � Siding 8 Restoration ❑Other: (specify) Phone: 952-471-0590 <br /> „ Fax: 952-471-0682 <br /> ,�Re-roo ❑ Fire Damage www.minnehahacreek.orq <br /> verall Project Description: 'j��:.r � ' ���y'D� h;;(,���. Z � , jj4 S S. <br /> Estimated Construction Valuation of Project(excluding land)� $ �S d0 �-C' <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the information, the application may not be issued. <br /> ApplicanYs Signature: ����� ��-�.�"�" Date: �—�'� <br /> Reset Form <br />
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