Laserfiche WebLink
, �,�1, 22, 20'�� 6 9; '�RN1 No, 2840 P, 1 <br /> ca� �� � � � � <br /> ,ty of rono <br /> _ _ ._Buil�ing P�r.mit.Application for Maintenance/ Replac�ment I Remodel Re,s��ie'ntial ON�,1( <br /> (i.�. windvws, doors, siding, r�-roof, et�. —NO STRUCTURAL �XPANSION) <br /> n Mailing Addr�ss: permit numb�r; c�� <br /> ���� CO sai Ba ,MN 55323-0066 Ra.e�eGe�Y.. <br /> , �:. <br /> d ::: � ` <br /> rY Y t': e � <br /> � StreatAddiass: Received byi �, <br /> ti� �� 2750 Ketley Parkway Pl�n fev��w fee^ <br /> Orono,MN 55356 <br /> �'Kes t�a�'` <br /> � �'ot21 Fee � ��` <br /> Nlain' �J52-249-4600 Fax' 952-249•4616 www.ci.orono.mn,us <br /> ,,.. �. .. <br /> This a lication Fdrm must b@ completed in full and all required informatian must be s' .. . ...... .. ..... .. <br /> pp ubmitted. <br /> Incomplete a plications will be returned, (Please print) <br /> GEN�RAL INFORMATION: � <br /> Job Site Address: <br /> Will this be a Parade of Homes,Remodelers Sho case Home or ather Di lay Home? Yes No <br /> 1P yes,a special event pem�rt is required wrth Polrce Department and Clty Counc!!approval 6p days prror to the evenf, Shuftle bus rvica wpl be <br /> required unless applicanf demonstrates sufflclenf onsNe parking Is avallable. Non-permitted evenfs wi!!not be a!(owed. <br /> CON7RACTOR 1 A�ICANT' tYFORMATION; ' <br /> Name� <br /> State License# Expiration Date: w <br /> Lead Certification Number: � Expiration D�te: <br /> (for work on homes that were cons ructed ior#0 197 J <br /> Phone; (cell �� � �p� (off1Ce <br /> Mailing Address, f' . � � Ci ZIP� � <br /> Contact Person; A II ant is: ntr ct r / Homeowner �circie one� <br /> Email and/or Fax; J <br /> PROPERTY OWNE INFORMATION: �� <br /> Name: <br /> Phone(day); � nI / <br /> /� /��_� � <br /> Address: Clty' �Un� ZIP: � �/ � � <br /> Email and/or Fax� ��J <br /> PROJECT INFORMATION: Overal� ro�ect descri tion� <br /> Type of Project: Any earth movement may afso require <br /> ❑ Door(s} ❑Remodel ❑Fire Damage MCWD review 8,permits: <br /> ❑Re-roof,asphalt ❑Repair []Storm Damage Minnehaha Creek Watershed Disfrict(MCWD) <br /> 15320 Minnetonka Blvd <br /> ❑Re-roof,cedar 0 Restoration ❑Water Damage Minnetonka,MN 55345 <br /> Re-roof,other a eci Phone: 952-471-0590 <br /> 0 ( P fyy ❑SidinB �Other:(specify} Fax: 952-471�0682 <br /> indow(s) www.mfnnehahacreek.ara <br /> Estimatecl Construction aluatlon of Project(excluding land) $ � <br /> APPLICANT ACKNOWLEDG�MENT: <br /> • Agrees to provitle alf information requlred or requested by the euilding Department; <br /> . Certifies that fhe information supplied is true and correct to the best of hislher knowledge. 7he appiicant recognizes ihat they are <br /> Solely responslble For submitting a compl�fe appfication being aware that upon failure to do so, the staff has no alternative but to <br /> rejecl it until it is camplete; <br /> • Some or all of the information tha� you are asked to provide on this appiication is classified by State law as either private or <br /> confidential. Private data is information whiGh generally Cannot be given to the publlc but can be given to the subject of the clata. <br /> Gonfdential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> fntended use of[his information is to annually update our�eCords ancl reCo�ds of other c�overnmental agencies required by law. If <br /> ou refuse to su ! the i rmation he a lication ma not be issued, <br /> Applicant's Sic�nature: �l. Date: ' / <br /> Owner's Siynature: Date: <br /> Last Updatad:January 201E ; <br /> i <br /> i <br /> � <br />