2014-00379 - siding - Laserfiche WebLink

Home Browse Search

� ` City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) ,� ['�A, MeiNng Address: Permil number 1�*-'•VO PO Bax 68 Crystal Bay, MN 55323-0066 Date received: St►t�et Address: Received by: � � 2750 Kelle Parkwa S'�, G. Y Y Plan revl�nr�: 1,�k�s„o��, Orono, MN 55356 �G Total Fee� ��, !" 1 Main: 952•249-4600 Fax: 852-248-4616. www.ci.orono.mn.us /v This applicat�on form must be completed in full and all required information must be submitted. Inc4mplete applications will be returned. (Please print) GENERA�1NFORMATION: �D�D �� . �� Jcb Slta Address: Will thiS be a Parade at Home6, Remodelers Showcase Wome or other Display Homea Yes No K yas,a speael evenl permif is required wrth Police Dapertmant and Crty Counal epprovel 60 deye p�lor'lo the eveM. Shutlle bus i will De required unless appliCant demOn6trdles suf�iCient on-siha paricing is svailabfe. Nan-pertnitted events will not be ellowed. CONTRACTOR!APPLICANT IPIFORMATION: Name: State License# Expiration Date: Lead Certification Number: Expiration Date= (for work on homas that were constructed prdoi to l978 Phone: (cell) (office� Mailing Address: Ciry� ZIP: Contact Person: Applicant is; Contractor ! Horneowner �c��a onB� Email and/or Fax: NaOe ERTY OWNER INFORMATlON� ' � � �( �� G Phone(day): Gj� Address: City: �� ' �j ZtP: �� P� Email and/or Fax: �'(? � PROJECT INFORMATION: O�verall ro ea descri tion: �G�X �� a �� Type of Project: Any ep�movement may also r�quire ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD revlew 8 permfts: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonke Blvd ❑ Re-�oof, cedar ❑ Restoration ❑Water Damage Deephaven,MN 55381 (] Re-roof,other(spec�f�+) �Siding ❑Other.(specify) Phone: 952�171-0590 Fax: 952-471-0882 ❑Window(5) www.minnehehecreek.orq � Estimated Construction Valuatfon of Project(excluding land) S _ � � > > G� APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Depaitment; . Certifies that the information supplied is true and correct to the best of hislher knowledge. The epplicant recognizes that they are solely�esponsible for submltting a complate application being aware that upon failure W do so,the staff has no atternati�e but to rejed it until it is complete: . Some or all of the informabon that you are asked to provide an this appllCation is classified by 5tate Iaw as either private or con6dential. Private data is infarmation which generally cannot be given to the public but can be give� to the subject of the data. Cor�fidential data is information which generally c�nnot be given to sither the public or the subject ai the d8ta. Our purpose and intended use of this informaaon is to a��uslly update our records and recprds of other govammental agencies required by law, If ou refuse to s I the ir�formation,the a lication not ba issued. Applicant'S Signature: % - � � � f Date: �'� � Owner's Signature: � Date: Lasc Updated:03/06/2013 Z0/I0 3�Jt7d ONO2i0 .�0 l�lI� 9Z976bZZ56 9L�60 CiOZ/SZ/h0