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Feb 02 15 09:36p Midwest Gutter & Siding 763-694-8989 p.1 ' � City of Orono Building Permit Applica1tivn for Maintenance / Rep�acement 1 Rer�odel � � 1 MailiPJ Box 66. Permit number. C S - ' � 1 `� vl� �� Crystal Say, M N 5 5 3 2 3-0 0 6 6 Da te receive d: 'L - � ` �� � ( Received by: i��C� r� ��`1 a � 5treet Address: __ \ �l� �� 2750 KelEey Parkway Plan review fee_ �� Orono, MN 55356 ��CSti��Q'�. „�- 7otal Fee: Z'ZL� • �� Mai�: 952-249-4&QD Fax: 952-249-4696 �.^,�vnrl.ci��ro�o,mr_us This appfication form must be completed in fu11 and aH required informatio�must be subm�tted. Incomptet�e appl�catior�s will be retumed. (Piease prinf) GENE��AL INFORMATiON: � r'` � y� Job Si9:e Address: , �`'� � C�Q r�L �-�,C-.� �,(� �� '�(�c_��-' L� l '� � Will this be a Parade of Homes, RemodE:lers Showcase Home or other Display Home? ❑Yes No K yes,a special event pemat is requrred with Po/;ce Depa�trnent and City Council approva160 days pnor ro the evertt Shuttfe bus s wa'!ba required unless applicarrt devnorutrates sufficient onsrte park�g is available. 1Vorrpem�itted evenPs will not be allowerl CONTFtACTOR 1 APPLFCA11tT {NFOR ATION: Name: �--� �r' �� (�-��-�� f- S•��.�-� y�� -- State l.icense# �_�a;�-� `Z Expiration Date: G�� 3,, - ( �, Lead Certification NUmber: �j_ ,��J - � Expiration Date: f;(� _ /S�' - ��, (Yor��vork orr homes Lfrat were construct�d prior ra i978 Phone: (cell) 's�,� -S�� . ��R.� (office} ` ,t� Mailing Adctress_ ,�t, �'�- �� . J�-� � Ci � � ZIP: . �./ 'L Contact Person: ; ,� ;k�j� Applicant is: Contra or / Homeowner tcu�ie o�a� Email c�nd/or Fax: 1��'-►`�(.�e S'] : �r��-�?Z�1�n.� ��' f�"�b. -('` � -_---- � PROP@=RTY OWNER 1�11FORMATION: Name: ��:rP�rZ`�S � ► f�� _ Phone (day): ''Z � � �� _ r �`� k Address: ' 'jc� �'� �a�L��-�� .n� �� C�'/1-��,�1�IP: Cj,?j _ Email andlor Fax: ? / - PROJECTINFORMATIOI�: OveraN ro"ectdescription: `�� -> �� l-�x-r� � Type o1(Praject: � Any eaHh movement may also require ❑Doa�(s) ❑ Remodel ❑ Fire Damage � MCWD review 8�permits: ❑ Re-roof,asphalt ❑ Repair ❑ Storm Oamage , Minnehaha Creek Watershed C)istrict(MCWD) 18202 Minnetonka Btvd ❑Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55331 ❑Re-raof,other(spec'rfy} �Siding � ❑Other.(specify) Phone: 952-471-0590 cen�� Fax� 952-471-Ofi82 ❑Window(sj ��w�;�., innehahacreek.orq Estim<rted Construction Valuation of Project(excEuding lancf) ; �--'� Ci"if'=f� APPLdCANT ACKNOWLEDGEMENT�, � Agrees to provide alt information require�i or requested by the Building DepartrnenT, � � Certifies that the infarmation suppiied is tnae and carcect to the best of hislher knowledge. 7he applicant recognizes ti�at they are solely responsible for submitting a complete application being aware that upon failure to da so,tt-re siaff has no alternative but to reject it until it is complete; ❑ Some or al� of the informa�on tYsai yau are asked to provide on th+s appfication is cfassfied by State iaw as either private or conFdential. Private data is infnrrnation which genera4ly cannot be given t�the public but can be given to the subject of;he data. Confidentia) data is infarmatior� which generally cannot be given to either the public or fhe sub}ect�f the data. Our purpose and inter�ded use of tfiis informaroon is to ar�nually update our records and records of other govemmerrtal agencies required by law. !f ou refuse to su e inforrnation e licatiom m �otbe issued_ ApPlic2int's Signaiure: ' �-�� '��'�5'�L "-' Date: � � �` ' �� Owner's Signature: ��e' Last E7pdated:January 2�15