Laserfiche WebLink
. <br /> City of Orono � � �� <br /> - Building Permit Application for Maintenance / e\ vation <br /> (windows, doors, siding, re-roof, etc.) <br /> ..-:.- - Meiling Add��ss: PenTlil nwllber. <br /> .CL,�_`�� P�Box B6 - 2C <br /> �Qy_ �O Crysta� I:�ay, MN 55323-QUGG Date reCeived: ��//- �gJ/ <br /> � r� " <br /> � +�' o. StroctAddr�ss, Raceived by <br /> \�'�+ �� 2750 Kelley Perkway Plan review fee: <br /> �`�g�auo4'�;''� OfG�IU, MN 5535ti <br /> '--'���� Tolal Fee, �9�, � <br /> Main: 952 249-4600 Fex: 952-249-4616 www ci vr�uio.rnn us <br /> This applicetion forn�must be completed in full and all required information must be submittCd, <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION; (��� ,_ . <br /> Job Site Address: � � � � � _ ► t'"l J�. ���j <br /> I�C� _..:. �_ „ <br /> Will this be a Parade of Homes, Renlo�l� ShowCasE Home or other Display Home? Yes �No <br /> �r yos e SpBtl�l evAnl pArmil i5 required wifh POIiCe Dep�IlmCr)��ntl Clly Cuunul�pprov�l 80 deyy piior lo the evan� Shuhl9 hU3 56NIrg Wjll bN <br /> /uQunCrd U/iIHS9 t1ppGCfJIII C�@I/70/13tfBf63 3U(flCle(!f 0(I•site parking Is availa6la. Nnn-permlrFAd avAnf�will not be aUowad <br /> CON7RAC70R!APPLICANT INFORMATION� �j <br /> Name. �L� '- ''VI ._Q.�l.{, ����.- <br /> Statc License# '— — �� � ' � <br /> � �� E iration Date; 0� ?�I �.L__( <br /> Lead CerLification Number: Expiration Date: <br /> --- <br /> (for woNc on nomes that wvro construct�ed prior to 19T8 _ _ <br /> Phone: (office) • �. ....�Q� ��>�k�'�__.. (celq <br /> Mailing l�ddress: � (�, ' �,� 'ty: " ZIP: �"�.?-!(k, <br /> • _._... .. --- <br /> Contact Peison. �f �k��� � i � Applicar1t15: Contrac or I omeowner �Clrcl�puu� <br /> Email and/or 1=ax: - - � ' ) � <br /> N L?1V�C��'X-P VQ����- VYl _. e- �l In,�7�C� �L"�W1 G_.� � . C�J�'Yl <br /> PR�PER7Y OWNE NFORMATIO • —� <br /> Name• ,L ) <br /> ..... -- <br /> Phone(daY): (,h I - "��-�� — _...�j �J <br /> �ddress- 6 C� C.L1�R.i rl 2�_ `��e��.�. ��ty- �-��a u,�? . z�P� ...�� 2��� <br /> Email and/or Fax � <br /> PROJECT INFORMATION: <br /> Type of Project: �� � Any ea�th movement mey r�quire <br /> ❑ Duor(s) ❑ Remodr:l ❑ F�re L�am2r.�e MCwn��viAw�pqrmits� <br /> M�nnehahe Greek Watershed District(MCWD) <br /> �f Ry-�nof,asphalt ❑Repair �Storm Damage 18202 Mirirtelunka lilvd <br /> U Re-iuuf.Ceder �h�esloratiqn ❑W2�te�D�mage �@ephaven,MN 5(391 <br /> Phone: 9�2�71-0�90 <br /> ❑ Re-iouf,olher(spoclfy) [J 5iding ❑Other' (specity) Fax. 952-471-0681 <br /> ❑Window(s) www.inii„inet,i�li,dci,tek.UtQ <br /> ...—.... ............ ..-------.. <br /> Overall ProJcct Doscrlption; <br /> - -._. ......-- <br /> Estimated Construction Valuation of ProJect(excludln lana) $ , 7� <br /> APPIICANT ACKNOWLEDGEMENT: <br /> _.._...... .... <br /> � Agrees to provide dlt uiformeiinn required nr r�quested by the �uildinc� Oepartment; <br /> • GeRltles that the information supplied is frue and currecl lu lhe best ot h�s/her knowledge The applicant recognizcs that they <br /> are solely responsiblc for submitliny a cuiriplele applicetion being aware that iapnn f�ilure to do so,the st�ff has no allcrnalive <br /> but to reject it unlll it is complele, <br /> • Sume ur dll of the information that you are ask�d to provide on this application is classifed by State Idw dy eiirier private or <br /> confidenti�l. Private data is information which gener211y cannot bc givcn to lhe publiC but Can he given to the suhjAct of the <br /> dala. Confidenfial data is informdtlon WhICh generally cannot be givcn tu ei�lie� 1he pubhc or the subject of the data. Our <br /> purpose and intanded ll5e of this infortnation is to annually updal� our recnrds �and records of other governmentdl �gencies <br /> � _required by law. If ou refuse io su I the information Ihr�y>)6cet�on ma �ot be issued. <br /> A��plicbnl's Signature: �l.�[-� � �_� �.�• D�le� _ R '� � � _ �r1 �� <br /> Lasl Updaled: 08•09•2011 �I n,�, �/, ��� ` �rJ ,f � ` � " + I <br /> �(,�1 �- ('� C �. r � '-�� ,l�� J�T�- �L�Ci� r�l� <br /> � <br /> >, <br /> �� � I� 1'1 1/`� <br /> S�ti'd 9ti9b6bZZS6+:ol OSSbSZZZti9 ��d Jd�1f1�Sd(10I0�1d��'���� 80�TZ ZtiOZ-Oti-Jfld <br />