2011-00639 - windows - Laserfiche WebLink

Home Browse Search

Jul. 12. 2011 2; IOPM No, 7591 P, 1 City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: d p� „�� O�,�,�0 PO Box 66 Permit number: _ L_ Crystal Bay, MN 55323-0066 Date received: � � ,. Street Add/ess: Received by: _ '�' '�' � 2750 Kefle Parkwa � � `, y Y Plan review fee: �x,�e�o4,,�� Orono, MN 55356 "=• —=' Total Fee: � 3 7'. (p� Main: 952•249-4600 FaX; 952-249�616 www.ci.orono.mn.us This apQlication form must be completed i�full and all required information must be submitted. Incomplete applications wlll be�eturned, (P/ease prrnt) GENERAL INFORMATI�NyU��O 1 �� Job Site Address: Will this be a Parade of Homes, Remodelers Showcase Home or other Display�l-lome? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approvel 60 days p�or to tha even�. Shutde bus service w;u be required unless epplicant demonstrates su�cient on•site paricing is available, Non-permifted events wlll not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name; 5 c.►�o�r e-� 1(3v�5 _ . . . .... ........... State License# �o;�3 q�3 l"o I' „� Expiration Date: 3�/�. �.._.... Phone: yS3—� 7 7-- /�o..C� office . . �cell„__ _._._........._...._.... _..,:-�-- ---�-._..,._.. Mailing Address: o i � c �e. (u�.._,.,.......:....._. Ci ; o "�h S ZIP: �S 3�/ Contact Person: _��}-�y._.._ .,�c�v�,�c�C; Applicant is ontrac o / Homeowner �a«ioo�o� Email andlor Fax: ti..�r �s�-a-� 7— /(0 9v_,_, , ,__,_,_. PROPEt2TY OWNER INFORMATION: Name: ?a c l� 1.�. �c{ _._......,,..,...------- Phone(day)� �Sa= -- �l ��....M.,i�--0 1 4.GL c� Cit C� r� Address: (, y: ✓v o ZIP� SS3�`l _..............._...--�--....._ Email and/or Fax ---_.._,.. -.--.--- ---. -- PROJECT INFORMATION: Type of ProJect: Any earth movement may require MCWD revlew&permlts ❑Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWD} ($Window(s) ❑ Repalr ❑Storm Damage 18202 Mlnnetonka Blvd �eephaven, MN 55391 ❑Siding ❑ Restoration ❑Other.(specify) Phone: 952�71-0590 Fax: 952�71-0882 ❑Re-roof ❑ Fire Damage www.minnehahacreek.ora ---..._..... Overall Project Description: �h � � Fk I t �v�.�»-e w� cu,s `� +-. .�e�c�s{=�c, o,�e ii�1;ha5 Estlmated Gonstructlon Valuatlon of Project(excludin� land) $ � ') ��.CrO APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Departmen� • Certifies that the informalion supplied is true and corred to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that 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 application is classlfied by State law as either private or confidential. Private data is information which genarally cannot be given to the public but can be given to the subject of the data, Gonfidential 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 r�cords and records of�Other governmental agencies re uired b law. Ifyou_refuse to supply the information,the application may not be issued. Applicant's Signature; �^- � � Date: ��"��' — �� Last Updaled: 05-04-2009