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' City of Orono <br /> � Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> ��/.¢,�,�.\ PO Box 66 <br /> iF Q Crystal Bay, MN 55323-0066 Date received: <br /> � z�" _* Received by: <br /> � ,� � � Street Address: <br /> 1 � � :;- � <br /> \\�, � �ti 2750 Kelley Parkway Plan review fee: <br /> \�ykESH04,� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 4470 Forest Lake Landing <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Coty Construction and Remodeling <br /> State License# BC-20431519 Expiration Date: 03/31/2012 <br /> Phone: (952) 934-7600 (office) (612) 599-8387 (cell) <br /> Mailing Address: 5��ti vien Ave City: Minnetonka ZIP: 55s45 <br /> Contact Person: Pat Cotv Applicant is:�Contractor / Homeowner (Circle One) <br /> Email and/or Fax: pat(c�cotvconstruction.com (952)934-0099 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Steve and Jeannie Prawer <br /> Phone (day): (952) 546-5292 <br /> Address: 8313 W. Franklin Ave City: St louis park ZIP: 55426 <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review&permits <br /> ❑ Door(s) �Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> �Sid��2 � Restoration �Other: (specify) Phone: 952-471-0590 <br /> �, Fax: 952-471-0682 <br /> Bx Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: Tear off wood shake roof and reinstall w/same <br /> Estimated Construction Valuation of Project(excluding land) $ 15,927.00 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot ,� given to either the public or the subject of the data. Our <br /> purpose and intended use of this inforcrratta s to annu update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to su I the info io lication ma not be issued. <br /> Applicant's Signature: � � Date: 10/11/2011 <br /> Last Updated: 05-04-2009 <br />