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� ' ��111312013 06:51 < �AX) P.0011001 ��1,f l�� 1��-/� City of Oror�a Building Permit Application far Maintenance / Replacement 1 Renova�lon (No structural expansion. Only windows, doors, siding, re-roof, e�c,} Malling Addrass: % � i i� "��T� PO Box 66 PeRnit number: —c`-- - Crystal Bay, MN 55323-0066 Date received: ��-/ ` - � 3treet Addreas: Recelved by: y �` 2750 Kelley Perkwey Plan revfew fee: '�� Orona,MN 55356 � ��,� �KESHOR Total Fae: � t Main: 952-249�60� Fax: 952-249-4818 www.ci.orono.mn.us This epplication form must be completed in full and aU required i�formatlon must be submikted. Incomplete appllcatlons wl[I be returne . (Pleasa prinf) GENERAL INFORMATION: / O Job Slte Address: � Wlfl thls be a Parade of Homes, Remodelers Showcase Nom r other Dlspldy Home? Yes No !f yrs,e apecial event permM/s requlred wlth PoliCe Deparfinent end City C C1!approva!60 days pno�ta tha event. Shuftfe bua 8en�lca wlll ba roqulred unless appliCRnt demonstretes sulflcienf ari-aitB p8rfdng!s avallsble, Non-pBrmftted evants wlR not be sllowed. CONTRACTOR/APPLICANT IN�01�11fIATlON: Name: Lindus Coi�stru�tion �nc. State llcense# BCOa76�4 Expiretion Date: 03/31/14 Lead Certification Number: � Expiration Date: 05/15 (for wo►k on homes that were constructed prlor to 1978 Phone: (cefq (office) 715-684-�647 Mailing Address: 879 H 63 City: win WI ZIP: 54002 Contact Person: Am ilk Appllcant i . ontractor Homeowner IClrcle Ona) Email and/or Fax: am lindusco.com PROPERTY OWNER INFORMATION: Name: im Beise Phone(day): 9$z,471.9079 Address: 2437 Dun d Ave. City: Wa aata Z�P� 553 Emall and/or Fax: PROJECT (NFQRMATION: Overall ro�ect descrE tion: Type of Project: Any earth movement may also require ❑ Door(a) ❑Remodel � ❑ Flre Darrtage MCWD review&parmlts: Minnehaha Creek Waterahed District(MCWD) � Re-roof,asphalt ❑Repalr ❑ Storm Damage 18202 Minnetonka Blvd ❑ Re-raof,cedar ❑Restoration ❑Water Damage Deephavan, MN 55381 Phone: 852-471-0590 ❑ Re-roof, other(apoclfy) ❑5iding ❑Other:(specify) Fax: 952-471-0682 �Window(s) www,minnehahaCreek•ora Estimated Constructfon Valuatlan of ProJoct(excluding land) $ 24,000 A}�PLIGANT ACKNOWLEDG�IVI�NT: • Agrees to provid�all informailon required or r�queated by the Building Department; • Certifies thet the information supplled le true and corract to the beat of hislhar knowledge, The applicant recognlzes that they are eolely rasponslble for submitting a complete applfcation being awere 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 erm aaked to provide on this application ie classlfled by St�ta law as either priv�te or confdential. Private data is information whlch generally canno#be gfven to the public but can ba gfven to the 9ubJeci of the data. Con�denHal data is informatlon whlch generelly cannot be given to either the publlc or the subJect of the data. Our purpose and intended use of this in atlon Is to an uall update our records and recorde af alher go�ernmenta{agencies required by law. If ou refuse to su I e i rmation th a laatl not be Issued, Appllcant's Signature: Date: r Owne�s Signature: Date: Last Updated;03/08/2013