Laserfiche WebLink
# � � City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> � Mailing Address: Permit number: <br /> j%�v 0,�.� PO Box 66 <br /> / Crystal Bay, MN 55323-0066 Date received: <br /> I "v� O\ <br /> �� � �'�� �- � � Received by: <br /> �,� ��s`:;,. a, StreetAddress: <br /> .�,��M�"_. oti/ 2750 Kelley Parkway Plan review fee: <br /> �kESH�� Orono, MN 55356 � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �.� k � <br /> Job Site Address: � �� � �' C�/I�l c--�—=�c� � /�t.�-- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Polrce Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applrcant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: / <br /> Name: �c_ �.f_.� �� �'l�-� <br /> State License# Expiration Date: <br /> Phone: (office cell <br /> Mailing Address: � ,`;�,_;�.� � ' Cit : l�=/.�� ,r�i}-- __��---�1 : � �/,��, � <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> �.____ <br /> PROPERTY OWNER INFORMATION: C /- , �, <br /> Name: J� �TT ��'l�� <br /> Phone (day): �i Z�3`j ��' � <br /> Address: �i�3L � i n� �Jc,., ►_�/Lc v� �i Z`� CitY: �—c:tc.ti�,��-- ZIP: S��t��, <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review 8�permits � <br /> ❑ Door(s) Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> _Overall Project Description: /L���r,�� � n,�t���� �� �{��,,�.� /}�/✓� �%�� >r c�(�.1.� <br /> Estimated Construction Valuation of Project(excluding land) $ /� �C� <br /> APPLICANT ACKNOWLEDGEMENT: '° <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; � <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to nnually update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to su I the informa o ,the a lication ma not be issued. <br /> � ���, <br /> ApplicanYs Signature: Date: �l � <br /> L2st Update� 05-04-2009 <br />