2010-00098 - door/windows - Laserfiche WebLink

Home Browse Search

r , • City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: -� ; , ;; - �0.� PO Box 66 Permit number: ,�.- � � Q � Crystal Bay,MN 55323-0066 Date received: �_ . � : y, Rsceived 6 � �'�� `�� � �' �. Street Address: Y� �� 2750 Kelley Parkway Wlan review fes: ��tr�$Ho�.� Orono,MN 55356 "'f'otai�ee:, `�� :{ Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete appl3catfons will be retumed. (Please print) GENERAL INFORMATION: Job Site Address: '�5� ��(L1/l C_� �� 0✓�J�Q Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No K yas,a special event permit is required wlth Police Department and City Council approva/60 days prlor to the event. Shuttle bus servlce wiJl be required unless app/icant demonstrates su�cient on-site parking fs available. Non-permitted events wlll not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: State License# Expiration Date: Phone: (office) (cel l) Mailing Address: City ZIP• Contact Person: Applicant is: Contractor / Homeowner (Cirele On�) Email and/or Fax: PROPERTY OWNER INFORMATIR N: ,� \ Name: \� �U��Q,+v�i Phone(day): c�5� t��7� � �( �_ 5 Z U']1•_ , Address: r��[ �yi4�Y�rlc,v !N Ciry:Q�,�iV� ZIP: SS� S (7 Email and/or Fax ��u"ll �2.�1. •C�o� F'�X `1'S2 c{'�� 9,s�,u PROJECT INFORMATION: Type of ProJect: My earth movement may require Door(s) ❑Remodel MCWD review&perm(ts ❑Water Damage Window s Minnehaha Creek Watershed District(MCWD) ( ) ❑Repair ❑Storm Damage 18202 Minnetonka Blvd Deephaven,MN 55391 ❑Siding ❑Restoration ❑Other.(specify) Phone: 952-471-0590 ❑ Re-roof Fax: 952-471-0682 ❑Fire Damage www,minnehahacreek.ora Overall ProjectDescription: (�,NnOu�e- �f>qR Dg0`(Z-. �'�S c�,t,l �J� (,tJ��/ OUJ S Estimated Construction Valuation of ProJect(excludfng land) $ 3op� APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsibfe for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information Is to annually update our records and records of other governmental agencies re uired b law. Ii ou refuse to su I the information the a lication ma not be issued. ApplicanYs Signature: Date: Last Updated: 05•04-2009 �