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Jun � 1 � 2011 12 � 11PM it ' s a great day at boyer bldg � No � 9581 P � 1 �_ ` ^ City of Orono . Building Permit Application for Internal Work (windows, doors, siding, re-rodf, etc.) Mai�ing Address; ��I '�-�} :� �___= - �\ P�Trttlt number O��O PryBoxs y ° C stal Ba . MN 55323-0066 DatE recsiv�d: ' ' � '� � Street Addr�ss: Recelved by � �► �� 2750 Kelley Parkway plan ieviewf ` ��s�.o$'�i Orono. MN 55356 ;..... .' � - - �--- 7;Dtal;;Fee;,._. , -.... .:.:. .. - , = .. :.: .�.. :. Main: 952-249-0600 Fax: 952-249-4616. . www.r,i.orono,mJ).�uS .. ...".:�........, -�==- ....:.. : :� r ........:.........:................ ............---:: ,.,..__,.._.,:...•.�..�...::..::::,.::.:.;..;-;.;.,;. This application form must be completed in full and all required information must be submitted, � Incomplete applications wllt be returned. (Please print) GENERAL INFORMATION: Job Site Address: ��b0 ��G1t�� .K D��VL, .. __ . _ Will this be a Parade of Homes, Remodelers Shnwcase Home or other Display Nome7 ❑Yes No If yes,a specia/event peim;f is requ;red with Po�ice Departn�ent and Clcy Council approval Go days prior to the evenf. Slrortle bu s scro;ce will be required un/ess applicanl demonstretes si�cienf on•she parldng is available. Non-parmiNed evenfs wil/not be allowed. CONTRAC70R I APPLICANT INFORMqTION: Name- �io�✓ �µ�'�ds�� Cor(�.��i�.. State License# Zy ` Expiration Date; . . . _ Lead Certification Number:. _ N�}"r• 630��2_ � Expiration Date�. p}/o;�ZoJS . ... . _ ..... (fo�wo�k on homes that were canstiucted p�lor'to 9978 Phone_ °�S2• t'I�.S. '_�.Oq (office) ----b�a- �� a'b�Z (cell� Mailing Address� ��{ S (o�,,. ,�_ EDI City: �,wn�. e�. ZIP: ��3�y Gflntact Person� Na,.� a..-� Applicant is� on rac Homeowner �c�r��o�� Email and/or Fax; �r}1�4� Q �o��,v�,�,�!�,��q , �o�,•� PROPERTY OWNER INFORMATION: Name: ��ue �° F4 ic�% Gl�oi,✓, Phone(daY)'. �19�Z�° M�6� 9'��! --- - --- -..... .._.. ��b,0 F�' ��cf� G►^e.t�� pv�:V�.. City� 8�oa� ZIP: �"� q . ..— Address: � �� Emailand/orFax ��di�,.lE��i�h�� . �tlf�v► _... ......_. PROJECT INFORMATION: --�- - - -�- Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permlts: Minnehaha Creek Watershed District(MCW D) �`Window(s) ❑Repalf ❑Storm Damage 18202 Minnetonka Blvd Deephaven,MN 55391 ❑Siding ❑RestoPation ❑Othcr(speciiy) Phone: 952-471-0590 ❑Re,roof ❑ Fire Damage Fax: 952-471-0682 www.minnehahacreek.orv . _ .---. ... . .._ .... . ....._ OverallProj�ctDescription: �►-�oV�f, � ��4be W�;hdOJ� J-�+'�+�9tD- �'�+t. r�+�df._�.dl ��r.� �� X��U�C"/^�' yi Estimated Construction Valuation of Project(excluding land) $ 10�_� ' _ . APPL(CANT ACKNOWLEDGEMENT: . _. ...... _........ . ..._. _. . .. .--- • �qrees to provide all informati0n feqUlfed Or requested by the Building Department; • Certifles tl�al lhe information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so., the staff has no alterna tive but to r�eject it until it is complete; • Some or all of thQ information that you are asked to provide on this applica6on is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subjed of t he data. Confidential data is information which generally cannot be given to either the pub{ic or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmenlal agencies required by law_ If you rafuse,to.su�ply the information, the appfication may flot be issued. Applicant's Signature� _ �;�3y,J��ate� O(a181_l 2!1�� �', ._ Last Updated.� 03-Di-2011