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2014-00740 - doors
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Crystal Creek Road
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100 Crystal Creek Road - 33-118-23-33-0009
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2014-00740 - doors
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Last modified
8/22/2023 4:50:12 PM
Creation date
6/6/2016 12:59:19 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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' ` City of Orono <br /> Building Permit Application for Maintenance / Replacement / Renovation <br /> (No structural expansion. Only windows, doors, siding, re-roof, etc.) <br /> �^� Mailing Address: <br /> / �-0�� PO Box 66 Permit number: <br /> / 1 Crystal Bay, MN 55323-0066 Date received: <br /> � , � � Street Address: Received by: <br /> �,� '� �J 2750 Kelley Parkway Plan review fee: <br /> �� Orono, MN 55356 <br /> � F��k�s�p�� <br /> ___-- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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: �,/ / r <br /> Job Site Address: � r Cr��i� �G, d�Uj�� rn/V 7�.3✓�O <br /> Will this be a Parade of Homes, Rem delers Showcase Home or other Display Home? ❑Yes '�No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wi/l be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Srj�,�b CUr1,S"�77AG�76Y� <br /> State License# aC� ��(0� Expiration Date: � �� p� <br /> Lead Certification Number: L�'�-Gj7� Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (cell) (office) �p/Z-333r Io2� <br /> Mailing Address: (�j p p � �� City: pp �� h ZIP: G'j l�.�f <br /> Contact Person: r Applicant is: rac r Homeowner (Circle One) <br /> Email and/or Fax: p�, � /'j�, }� d l7. 0 <br /> PROPERTY OWNER INFORMATIOH: <br /> Name: �'f(�,�^�' tl� �'f .�f" <br /> Phone (day): Z— !� G,J <br /> Address: p� f f City: Q � o ZIP: S$�35�0 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Overall pro�ect descri tion: <br /> Type of Project: Any earth movement may also require <br /> �Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: <br /> ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.orq <br /> Estimated Construction Valuation of Project (excluding land) $ � D 0 <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 are <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to <br /> 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 data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> ou refuse to su I the information,the a lication ma not be issued. <br /> Applicant's Signature: Date: <br /> Owrer's Signature: Date: <br /> Last Updated:03/06/2013 <br />
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