Laserfiche WebLink
1 . . <br /> City ofi 4rono <br /> Building Permit Applicatian for Maintenance 1 Replacemen# I Renova�ion <br /> No structural expansion. Only windows, doors, s�ding, re-roaf, etc. <br /> �} Mailing Addt�ss: .: � � <br /> �Q�V� PO Box 66 Permit number p��.� <br /> Crystal 6ay, MN 55323-0065 Date reCeived. _ ,. ' - • —� . „:: <br /> ,� Streef Address; I��cei�ed b'y ,',: <br /> `S�, �' 2750 Kelley Parkway Plan r9Vi e • `'. <br /> ��� sr-1o'�`�`4 Oronp,MN 55356 �, ' <br /> 7'nt�l.Fee: ����'�" <br /> Main: 952-249�600 Fax: 952-249-4B16 www,�i.arono.mn.us <br /> This application form must be�ompleted in full and all required infnrm�tlon must be submitted. <br /> ln�amplgte applications wi�1 he returned. (PI$�se print) <br /> GENERAL INFORMATION: <br /> Job Site Address: j� 70 f-�,t�� ��p�� �,..,_ ��,.�,o �'S"�`�� ( <br /> Will this be a Par'a�t(e of Homes, R,emodelers 3howcase Hame or other Dlsplay Home? Yes No � <br /> lfyes,s spacial eve�t permi#is required wltfi Police Department and Cfty Couna�!approval Stl days pnor to the evenl. Shcrttle bus seivlce wTfJ 6e <br /> requlrgd unles.s applicani damonstrates sufficlent on-slfe perking is availabla. No�pemtitted even[s will not be aJlowed. <br /> CUN712ACTOR 1 AF'F'LI�A INfORMATIQN, f <br /> Name; � r �, ��t�r�rD�S <br /> St�te License# [�G (0 3 y Gf�S' Explration Date: � g � �s-- — <br /> �ead Certification fVumber' ��''�{r'�r I3%S �" r �xpiration Date; 7 / �� _�_ <br /> (for work on hames th�t were constructedprior to 1978 . <br /> Phone: (cell) �P��-� � ( ^ 7 / (S (o�ce) ��� – 5` Z� � (°r <br /> Mailing Address: Q 3 ',� City� u,� ZiP� 1 Z S^ � <br /> Contact Person: r Applican is: Contract / Ho eowner <br /> (Circle One) <br /> Email and/or Fax; �. �, � ��,,, _ � ��,� � µ� 1 <br /> .PROPERTY OWNE INFORAAATIaN: <br /> fdame: t w � <br /> � <br /> Phone(day)� T ! - 3 D -- `Z J <br /> Address: ��'Q r --�e.�l�. �. �itY' i`0 r..A ZEP: SS � l I <br /> Email and/or Fax: ' <br /> PROJECT INFORMATI�N: bverall ro'ect descri tion: <br /> Type of Project: Any earth movement m�y also requ[re <br /> ❑Daor(s) ❑Remodel ❑F�re Damage MCWD review&permfts: <br /> ❑ Re-roof, asphalt ❑Rep�ir ❑Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 1$202 Minnetonka Blvd <br /> �ae-roof, ceder ❑ RestoraUon �Water Damage Deephaven,MN 55391 <br /> ❑Re-roof,other(specify) [,j SEding ❑Other.(spocify) Phone� 952-471-0550 <br /> ❑Window s Fax: 952-479-0692 <br /> � � „_.,_ ww�,v_minneJ��l��Creek orq <br /> �stimated Constructlon 1/aluation of Projact(exciuding land) $ , � " <br /> APPLiGANT acKNOw�,EDGEMENT: <br /> • f�qrees ta provide all information required or reyuested by the Building pepartment; - <br /> • Gertlfles that tha information supplied is true and correct to the best of his/her knowledge. The ap�licant recognizes that they are <br /> solely responslble for submftting a complete applicafion being aware that upon failure to do so, the staff has no altemative but to <br /> reject it until tt is complete; <br /> • Some or all of the infatmation that you are asked to provide on thls applicatiQn is classifled by State law as efther private or <br /> confidential_ Pnvat�data is Pnfvrm�tion which generaily cannot be givan 10 the public bu#can ba given to the subject of the dat�. <br /> Confidenttal dats is information which generally cannot ba given to elther the public or the subject of the data. Our purpose and <br /> intgnded use of Ii115 info tio 3nrlually update our records a�d reCords of other gov�mmentel agencies required by law. ff <br /> ou refuse to su 1 th inf r n the a lication may nai be issued. <br /> AppGcartYs Signature: w Date� � � �"`J `� � <br /> Owner's Signature: Date; <br /> Last Updated:43/o6/2013 <br /> �' ��a � �' 79��5��z �-r�6a - 75`�3 <br /> �xa_ D Cv,!� Q„ �� 7 <br />