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09-12-13;10:56PM;From:kuhl To:9522494616 ;9522588300 # 2/ 2 <br /> , � <br /> �Building Permit Applicatian for Maintenance / Replacement / Renovatran <br /> (No stiructural expansion. Only windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit nurr►ber: <br /> �QNQ Po eoX ss <br /> Crystal Bay,MN 55323-0066 Date reCeivBd: <br /> ,� � Str�etAddrgsS: RgCeived by: <br /> % h 2750 Kelfey Parkway <br /> f �� Orano,MN 55356 Plan review fee: <br /> ���6s�•�o�t` <br /> Total Fee: <br /> Meir1: 952-249-4600 Fau' 952-249-4616 www.r.i.�rono.mn.t�s <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applicatiOns w911 be�atumed. (Please print) <br /> GENERAL lNFORIUTATION: <br /> Job Site Address: 65��RNDALE�REEN Wi4YZATA MN <br /> Will this be a Parade of Homes,Remodelers Showcase HomP or other Display Home? Yes � No <br /> !f yes,a speciel evenc permit is r�quired wlfh Police Dapertment snd C!ry CouncfJ approvs!60 days pvior to the avenc Shuft/e bus serv�ve wlll bs <br /> requir�d unless appllcpqt derllonsbates SuflSCiant oR-site paridng 15 6veil8blg, Non-permitMd events wlll not b9 allowed. <br /> CONTRACTOR 1 APpLICANT 1NFORMA710N: <br /> Name: Kuhll�s Contracting <br /> State Licens8# �C195T69 Expirdtion Date: 3131li5 <br /> Lead Certification Number' CL1341722034 Expiration Date: a�77/2oia <br /> (for wonk on homes that we�constructed p»or fa 1978 <br /> Phone: (cell) (office)952-935-9469 <br /> Mallt�g AddfeSS: 1595 Squtfl 5th Stl"6et City;Hopkins ZIP;�j5343 <br /> Contact Person: staci�Rice __ Applicant is: ContraCtor / Homeowner �ctnio one� <br /> Email and/or Fax: ���� ,kuhtdestpnbuild.com <br /> PROPERTX OWNER IN�ORMATIQN: <br /> Name: 1im LePert� <br /> Phone{day): 952-935-9469 <br /> Address- 65 Ferndale Green City;Wayzata ZIP; <br /> Email and/or Fax: <br /> PROJ�CT INFQRMATION: Overall ro'ectdescri tion:" �- � - . <br /> Type of Prdject; Any e�rth movement may alsa require <br /> ❑Door(s) [j Remodel ❑Fire D2mage MCWD review&permits: <br /> ❑R�roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed DistriCt(MCW17) <br /> 18202 Minnetonk2 Blvd <br /> �❑R�rOof,Cedar ❑ Restorc�ti0n ❑Water Damage Deephaven,MN 55381 <br /> ❑Re-roof,other(spec�fy) ❑Siding ❑Other:(speciijr) Phone: 952-471-0590 <br /> Fax: 952-471•0682 <br /> ❑W,ndow(s) www.minnehahacreek.orq <br /> Estimat�d Construction Vale,ation ort Praject(excluding land) $ � <br /> APPLICANT ACKNOWL�DG�MENT; <br /> • Agrees to provide alf infOrrnation required or requested by the 8uilding Department; <br /> • Certifies that the information supplied is true and correct to the best of hls/her knowledge. The appAcant recagnizes that ihey are <br /> salefy respansib{e for submitting a complete applicatian being aware that upon failure to do so, the staff has no aftemative but to <br /> reject it until it is comple#e; <br /> • Soma vr alf of the infonnation that you are asked to provide on thi8 applicatlon i8 classified by State {aw es eithe� private Or <br /> confldential. - is infort�i-dtio hich generally cannot be given to the publiC but qn be given to the subjact of the data. <br /> Confiden' data is inform 'on whic nerally pnnot be given to either the publiC or the subject of the data. Our pufpose and <br /> intende use of tttis inf r i nuafly up ate our records and records of ot er gp emmental agencies required by law. If <br /> ou ref se to su ! th info the a liCati n ma not be issued. <br /> ApplicanYs ignature: Qate: <br />