2016-00104 - windows - Laserfiche WebLink

Home Browse Search

FEB/0�/%0�6/TUE 12; ?� P.?'� Elder Jones Bui lding �,;;1: ':�io, ��% �"��' �9�'9 F, 'i�'�� ' City of �ror�o �Buti[ding Permit�l Application for Maintenance / Replacement/ Remodel — R�sidentia� QNLY (i.e. �ncfvws, doors, sid'rng, re-roof, etc. � NO S�RUCTURAL EXPANSION) �� ! Mailr'ngAddress: Permit number: — '(�j' �� PQ Box 66 Crystal Bay, MN 55323-0066 (7ate received: —� `� � I Street Address: Received by: � ti � 2750 Kelle Parkwa ��,., G� I Y Y Plan review fea: � t��s �U �, �I Orono, MN 55356 � � � Total Fse: ` : ��I , Main: 95�-249�600 Fax: 952-249-4616 www.ci.orcno.mn.us This ap�lication form must be corrtplefed in fu}I and all required information must be submitted. Incomplete appliCations wilN be returned. (P/ease print) GENERAL �NFORM�TIQN: • Job Slte Address: i � 7 5 D� b Q r a��i �/'! V{. Wtll th(s he a Parad I of Homes, Remodelers ShpwGase Wome or other Display Home7 ❑ Yes ❑ No !I yAs,a speclal event�ermit is required with oolice Departmenr snd Clry Counell approva!60 days prlor to the event. Shurt/e bus service will be requlrod u less applicant demonstrates s�crent on�ite parking is evellable. Non-permitted events will not be allpwed. CONTRACTOR/APi�LICANT INF4RMATION: �� s �� 7 �o�' Name: , State License# �— THD A.t- Home Service, InC, Expiration bate� ��`�"'"�T�T'�"��`^__� Lead Certificafion Nu be 2690 Cumberland Pkury, Ste 300 Expirafion Date: (for work on homesli tha Atilanta, GA 3033��3913 Phone: �� Lic#CR268257 Ph. 763/542�5826 (offce) Mailing Address: . Cit : ZIP: Contact Person: Applicant i . Confractor / Homeowner {c��io o�a� Email and/or Fax: I1 O f� t S Q1 !.��l r_��i� L S L D !Yl 'tt PROPERTY OWNERIINFORMiATION: Name: ��K a -� h v � 1x1 � G� /� a /� Phone(day): ' r , � � o M q 10, Pl a�n Address: '�t 7's � !. G /� dl Dr r v�, Crty� P �II'� FJ_5 3 f'9 Email and/or Fax: ! PROJECT lNFORIV�ATfON: Overall ro'ect description: ; Type of Project: � Any earth movement may also require ❑ Door(s) ; ❑ Remodel ❑ Fire Dam2ge MGWD review&parmits; ' I ❑ Re-roof,asphalt � ❑ Repair ❑Starm Damage Minnehah�Creek Watershed District(MGWD) � 15320 Minnetonka Blvd { [,] Re-roof,cedar �i ❑ Restoratian ❑Water Damage Minnetonka,MN 55345 ❑Re-mof,other(speci� ❑5iding , Other: (SpeCify) 1 Phone: 952-471-0590 T t7 � ��}1 LJ J A�b W 1"! I�C l/1 Fax: 952-471-06F32 I��Window(s) � www.minnehahacreek.ora Estlmated Construc 'on Valuation of Project(excluding land) $ `f S ? APPLICANT ACKN WLEDGEM�NT: . Agrees to provide II Informatlon required or requosted by the Building bepartment; . Certifies that the i�fnrmatian supplied is true and correct to the best af his/her knowledge. The applicant recognizes that they are solefy responsible for submftting a complete ap�lication being aware that upon f�ilure to do so,the staff has no alternative but to reject it until it is c mplete; � 5ome or all of th information that you are asked to provide on this appiication is classified by 5tate EaW as either private or confdential. Priv te data is informatian which generally cannot be given to the public but can be given to the subject of the data. I, Confidential data� information whlch generally cannot be given to either the public or the subject of the data_ Our purpose and I Intended use of th�s informatian is to annually update our records and records of other governmental agencles required by {aw. If ou refuse to su I the information,the a plication ma not be Issued_ Applicant's Signafure: `I �J Date: '� �� " _w_, Owner's Signature: I Date: _„w Last Updated:January 2016 i I j .