Laserfiche WebLink
Sep 27 16,04:25p Advantage Construction 7634137245 p.1 <br /> Clt�/ Of �1'OI'�O <br /> Building Perrnit Application for Mair�tenance/Replacemenf/Remodel — Residen#ial ONLY <br /> Mailing Address: � ` ���� <br /> ���� PO Box 66 j.. �M-�I,„ Permit number. <br /> i <br /> ( Grystal Bay, MN 55323-00�� � Date received: �� -�(p� <br /> .� <br /> Street Address: Received by: <br /> ��y�, � 2750 Kelley Parkway Plan reviewfee: <br /> l�Kk511���� Orono, MN 55356 ^ �� �� <br /> Total Fee: � �� , <br /> Main: 952-249-460� Fax: 952-249-4616 ww,v.ci orono.mn.us �� <br /> This application form must be completed in fuli and afi required inforrnation rnust be submitted. <br /> Incom�lete appfications will be returned. (Please priRf) <br /> GENERAL If�FORMATION!• ,�.��� <br /> Job SiteAddress: � ,� Q�../� � Q_�._�� <br /> Wil!this be a Parade of Homes, Remodele�s Showcase Home or ather Display Home?��Yes 'No <br /> !t yes,a special evenl permit is requirad with Police Department and City Courcil app�oval Ep days prror to the event. Shutue bus seN�ae wilf be <br /> requrred unless ap�licartt d2monsfrates su�cienf on-site parking fs availai�le. IV�n-permrtted evenfs wd!nof be allowed. <br /> CONTRACTOR/ PPLiCANTINFORMATION: . <br /> Name: �j� ,�tS`�'a � V f4-�'t'-U� s a C_.._ <br /> State License# L Expiration Date: 3 -,3 _� a/ <br /> Lead Certification lVumber: �/q� ., �C�f o�D- ,+ Expiration Date:`j L�� ,� �-/-� <br /> �,_F��5r <br /> {tor work on honres that were consiructed prior to T97B <br /> Phone: (celi) Z-(„��(3 - � (Q ) (oflFice) '"'?(43 -� � � _7 1�f'�` <br /> Mailing Address: .�a'(Q"� Qa.�,,.,'.��;a� S�- � city: -�—'�-�, z��:�c� � <br /> Contack Person: ���.,7 Applicant is: ontractor 1 H�meowner (CircloOne) <br /> Email and/or Fax_ s�.�y , q..�vQ Nrt-a����-,YR„�� � C�o ly1 � ��� �/�f �„ZS�� <br /> . _ <br /> PROPERTY OWNER INFORMATION: ,r <br /> Name: �..,�u �o�:N 1L vv� A N <br /> Phone {day}: <br /> Address: '"1S 1'��-tJ c�a.,g �_ ��h'�fea iZti-�1�,� ZIP: j�3� � <br /> Email andlor Fax: <br /> PRO,�ECT INFOAMATEON: Overal( ro�ect description����-' Q'l��<.� �-�- ��r <br /> Type oi Pro�ect: A�y earth movement may a�so req�ire <br /> ❑ Ccor;s) ❑ Rerrtodel ❑Fire Damage MCWD review&permits: <br /> e-roof,asphalt ❑ Re,�air (]Storrn Damage Minnehaha Creek Watershed Distnct(MCWD) <br /> ❑ Re-roof,cedar 15320 Minnetflnka Blvd <br /> ❑ Restoration ❑Water Damage I Minnetonka, MN 55345 <br /> ( P fY1 C g ❑ Other. (specify) Phone: 952-471-0590 <br /> ❑ Re-roof,other s eci � Sidin <br /> Fax 952-471-0682 <br /> ❑Window(s) _ rwow.minrtehahacreek.orq <br /> Estimated Construction Valuation of Project(excluding land) $ r <br /> APPLtCANT ACKNOWLEDGEMENT: CJ� �� <br /> • Agrees to provide all information required ar requested by the Building Department; <br /> • Certifies that the informaUon sup��ied is true and correct to the best of nisfier knowledge. The applicant recognizes that they are <br /> solely responsible far submitting a complefe application being aware that upon faiture to do so,the staff has no alternative but to <br /> reject if until it is complete; <br /> , • Some or all of the iniormation ihat you are asked to provide on this application is classified by State law as either pnvate or ; <br /> confidential. Private data is information v�h�ich generafly cannoi be given to ihe public but can be given 10 the subject�f the data. � <br /> Confidenlial data is inlorrr�ati�n wiiich generally cannot be given to eitherthe public or the subject of the data. Our purpose and <br /> intended use of this iniormaiian is to annually update our records and records of other govemmental agencies required�r law, If <br /> ou refuse to su I the inf ation the a lication ma noi be issued. <br /> ApplicanYs Signaiure����r�6ss� Date: � - � � ���'/s� <br /> f <br /> Owrers Signa:ure: Date: <br /> Last Updated:January 2016 <br />