2014-00032 - windows - Laserfiche WebLink

Home Browse Search

Tc�: Paye 3 of 3 20'14-0'1-�'1 '1�_O�:-IG(GMT) From� /�peu E�iargy Solutions � r� _ City of Orono Building Permit Application for Maintenance ! Replacement i Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.} �f��a +�\ MailiPO Boxr66 Permit number. 0�� I'�� �, � � Crystal 6ay,MN 55323-0066 Qate received: � - � � "� � 1 ' t Street Address: Received by: ; � � - �� 2750 Kelley Parkway Plan reviev� " f Orono,MN 55356 ��4KFsrco�`� '�-_._� 7otal Fee:��10�. 9 _ fvtain: 952-249-4600 Fax: 952-249-4616 �-v�rv�c.orcnovmn.us s � — ...__._._____...._ This application form must be completed in full and ail required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATtON: Job Site Address: " r. � ,. � �� '�G' - /t� 9 �:1rY1C��1� �r�r:�.►'l , 1�.,��.�r.��u._, +'1��.N ,� � y� i Will this be a Parade of Homes, Remodelers Showcase Home ar other Display Home? ❑Yes [,�No lfyes,a specia/event permit is reyuired with Potice Department and Cdy Councr!approva!60 days pnor to the event. Shuttte bus service will be required untess applicant demonstrates su�cient on-site parking is avaitable. Non-pem�itted events wifl not be allowed, CONTRACTOR J APPLICANT INFORMATION: Name: f�,i k �}'��i'-=, " `y.c��t.c.`t-c�-,tiS -- State License# � ' ' • Ex,a,;�� p� ----- �-.c sa `'i�-J ��.;,��4 ti� Ex iration Date �ead Certificatian Number; �y�}-`j �3� �y �--► Expiration Date ry�x,.� s.�-� 2�� (for work on homes fhat were constructed prior to 1978 Phone� (cell) ;�� -�,C� � �G'� �� i (office) ___. _ __�.� Mailing Address: ��4CyC �jr,�'tvtGr.r��«,lz. l.k-- �31VG�1 ��,c� te- �i.�.� City:�1GcY�ir�;-rot�� ZIP: ;r;�� 3�7 Conlact Person: �y-�- �+;,�4�,T Applicant is:� Contractor� Homeowner �c�.�ie o�e� Email and/or Fax: i:� (.�_�z'c�Ellr u" (e O�Y'Lt�� '�Y� PROPERTY OWNER INFORMATION: Name: _��.�s-�a4��r. �k ,<;�.�� ;�� 1�i Phone(day): �(��-.�:3�7 -G'�=��t ------ Address: _�G ��;'Y1�G'�� Gar'-P-�r• Ciry: iA:�.y;��cy:�b_ ZIP: rY1.N ��.�`j j Email and/or Fax: _ _-- - . PROJECT INFORMATION: Overall project descri tion: ___ Type of Project: Any sarth movement may also require ❑Door(s) ❑ Remodel ❑Fire Damage MCWD review 8 permits: ❑Re-roof,asphalt ❑Repair ❑Storm Qamage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑Re-roof,cedar ❑ Restoration ❑1h'ater Damage Deephaven,MN 55391 ❑Re-roof,other(specify) ❑5iding ❑Other�(specify) Phone: 952-471-0590 Fax: 952-471-0682 �Window(s) ev�.�wr;vrninnehaha�reek.orc_ � Estimated Construction Valuatian of ProJect(excluding land) $ y��j�'..,i,: G�C� APPlICANT ACKNOWLEDGEMENT: --.. .__.. • Agrees to provide all information re4uired or requested by the Building Departme�t; • Ceri�es that the information supplied is true and correct to the best of hislher knowledge. The applicant recognizes that they are ' solely responsible for submitting a complete application being aware that upon failure to do sa, the staff has no attemative but to reject it until it is complete; I • Some or all of the informatian that you are asked to provide on this application is classified by State law as either private or � confidential. Private data is infonnafion which generally cannot be given to the public but can tre given to the subject of the data. Confidential data is information which generally cannot 6e given to either the public or the subject of the data. Our purpose and i intended use of this information is to annualfy update our records and records of other governmental agencies required by law. If ou refuse to su I th .}n rmation,th licatiort rna not be issued. � .�. - / _.__ _. .- — — Applicant's Signature: � ='� � ' ��i��-- Date: 1 ,� ��_� /=��f� Owner's Signature: Date: Last Updated:03/Ofi/2013