Laserfiche WebLink
. ' City of Orano <br /> • Building Permifi Appiication for tnt�rrr�ai Work <br /> (windows, doors, siding, re-ro�f, etc.} <br /> Mailing Address. Permi�n�mbef: �O����� <br /> o�,�,�0 P�Sox 66 <br /> Crystal 8ay, MN 55323-0066 Date recerved: <br /> a . �, StreetAddress: Received by: <br /> ��n � ��^ �ti�' 275D tGelley Parkway Pia�reviewfee: <br /> '��og� Orono, MN 55356 <br /> Total Fee: ,��� , �p5 <br /> Mal�: 952-249-4600 �ax_ 952-24S-4S16 v�w.ci_osono.?�n.us <br /> This application form must be campieted in full and all r�quired in#ormatian must be submitted. <br /> Ir�complete apptications wili be reEurned. {Please print} <br /> GENERA�fNFORMAT[ON: /�.� ,/�, <br /> Job Site Address: �CXJ �c��� �i ,�,Jr', �/�C.��J f ,�'�7f2� �.�.�:�� <br /> Will this be a Parade of Hames, Remodelers Shawcase Homs or other Disptay Hom ? Yes No <br /> !f yes,a specia!svenf permrt is required with Polioe Deparimem and City Courrci!approvaf 60 days priar to the event 5hulile bus service wil!be <br /> r�qufreB unless applicairt demonstrafes suffrcisnt on-srte parking is available. Non-permitted evenfs w�l not be a!/owed. <br /> CONTRACTOR/APPLiCANT INFORMATlQN: <br /> Name: Ll.��d i���'r - �`�� �rr��r5 <br /> State l.ice�se# Expiration Dats: � �"�/ - �/�, <br /> Lead Certification Number: � /�- Expiration Date: <br /> (for work un fromes that were construcfed prior 9 �- <br /> Phone: E;'/� - .��1- '�/ � (office) � '���`�/�'�-s� (ce�!) <br /> MaiGng Address: � �/' � �r,,,J �P City: ���- �',�ZIP: f�� <br /> Contact Person: ,,, ; �,i �c,,�, ApPiicas�t is: rttracto / omeowner �circ�o�,e� <br /> Emaii andlor Fax: � Y � � �� - �_ --� <br /> PROPERTY�WNER INFORMATION• <br /> Name. �r'ilri�fir+-� L...r-.sT�, <br /> Phone(day}: ' ' <br /> Address: s�,�.,� City� ZEP: <br /> Ernail and/or Fax <br /> PROJECT INF�RMATiON: <br /> Type of Project_ Any earth movement may require � <br /> �]Door(s) Q Remode! �Water Darrrage �CWD review 8�permits: <br /> ❑V�ndow(sl ❑Repair orm Damage ���neltaf�a$202�nneetonka Bi��nct(MCWD) <br /> Q Siding ❑Restoration � ❑Other.{specrify) Deephaven, MN 55391 <br /> e-roof ❑fire Dama e Pfione: 352�71-0590 <br /> 9 Fax: 952-471-06g2 <br /> +rnn�,��.minrehanacreek.ara <br /> Overaf! Project Descrip#ion: `��- ' � <br /> Estimated ConstrtircE�on Valuatian of Project(e cluding fand} g G� <br /> APPL{CANT ACKNOWLEDGEMENT: <br /> � Agrees to provide all information required or requested by the Building Department; <br /> • Certifies tttat the information supplied is#tue and cor�rect to the besi of hislher kno�nriedge. The applicant recognizes that they <br /> are so{e{y responsibie for submifting a compieie application being aware mat upon failure to do so, the sfaPf has no alternafive <br /> but to reject it until it is complete; <br /> • Some or aA of the in#orrnatian that y�u are asked fn providE on this application is classified by State law as either pnvate ar <br /> confidentiaf. Private data is information rvhich general{y cannot be gfven to the pubtic but can be given to the subjecf af the <br /> data_ Confidential data is infonnafion which genera�ly cannat be given #o e'sEher the pu�iic or the subject of the data. Our <br /> purpose and intended use of fhis inf „ annuaFly upd2te our records and records of othee governmenta{ agencies <br /> r uiFed b law. !f ou raefuse#o su the ir�farmati e a lication ma not be issued. <br /> ✓ .,._. --- <br /> ApplicanYs Signature: •_' / Date: �- / � �f� <br /> Last Updaled: D3-09-2011 <br />