Laserfiche WebLink
NOV-29-2016 13:31 FROM:TREBILFOUNDATION SYS 3�05938720 T0:19522494616 P.2�3 <br /> . <br /> C�ty af Orono <br /> Building Pernnit Appl�cation for M�intenance / Renovation <br /> (windows, doo�� siding, re-roof, etc.) <br /> ��=� Mailing AddreSS' pQrmit number° �'�(�� ^C y�/� <br /> ��,O,�.O PQ Box 6fi <br /> � Crystal Bay, MN 55323�Q086 Qate rec�ived: �i-� � - <br /> � .. Street Addn�ss: Received by; � ` c <br /> 2750 Keilqy PerkwaY Plen review�e: �� ;''e.t' � 1= �r_C�'� <br /> �e��a�� 4rono,MN 55356 �� . <br /> Tptal�gp: <br /> Mafn: 952•249•4600 Fax: 952-24A•4816 www.�i.orono.mn.us �5 � 7 <br /> This appliC�tivn form must be completed in full�nd 811 required infprmatiQn must be submitted, <br /> Incomplete appllcations will be returned. (Ple�se prtint) <br /> G�NERAL INFORMATION: . <br /> Job slte Aaaress: �� �_ <br /> _._ . � . _��,.w .., _--._ _------- --- <br /> Will this b�a Parade of Homes,Romod�lers Sh case Nome or other Dlsplay Wome7 �Y� ��No <br /> M yos,9 spocra!evenr permlt!s rrqulnsa wltn Pp1;cs OvpeNmant and City Counc!!approvs!BO days p�ior to the event. Sl►uttk Dus snnrJce w1t1 De <br /> requl�ed unless applJcant demonStrAtlfS 8UJ1fClellf 0l1-81tA p8rking IS�v9Jt9blb_ 1UOn-p6+mi1t9d ev�ents wllJ noi 68 allowetl. <br /> CONTRACTOR f APP ICANi'IN��RMATIpNc <br /> IVam$. ��T � � � <br /> State License# Exp tion Dato: '� -- <br /> Lead Cartification Number: � Expi�tian Date: —� � <br /> (/or rvork on homvs chai wer�c�nstructvd prJor to 1878 <br /> Phona: �-. l ��ffice) � � (cell) <br /> Mailing Address: Ciry; ZIP' "� <br /> Cont�ct Pe�son: ��� ApplicanE is: ontra o / Homeowner �ci►�ie pna� <br /> �ma��and�or Fax: ln,� CQm <br /> � <br /> PROPERTY OWN�R lN�pRM/�TION' <br /> Name: <br /> Phone(day): p„ <br /> Address: � � City� rQ� ZEP: �`^���j� <br /> Email endlor Fax � <br /> �ROJECT INFORMA710N: <br /> Type of ProJect: Any oarth mpvement may repulr9 <br /> Q Door(s) []Remodel ❑Firg pamage MCWQ revlew&pormlia: <br /> Minnahaha Creek Watershed District(MCwD) <br /> ❑Re�root, asphalt �Repair �Storm Damage �82p2 Minnotonkp Btvd <br /> �RB-roof,cadar Rastoration �eePhavon,MN 55391 <br /> Q p water Damsge Phone' 852-471-0590 <br /> C]R8-ro0f,ather(epeclfy) ❑Siding [J Other. (specify) Fax: 952�71-0682 <br /> 0 Window(s) www.minnehahaCreek.ora <br /> Overall Fro eot Dascriptiort: <br /> �stimated Cqnstruction V�luation of PrpJeat(exCluding land) ^$ �� � <br /> APPLICANT ACKNOWLEDGEM�NT; <br /> • Agrees to prpvide all{nformation required or reGuested by the Building Department; <br /> • Certifios that the information supplied is tn,ie and correci to the best Of hislMar knrnMedge. Tha applicant recognizes [hat thG}r <br /> are solety responsible for submitting a cpmplete applir,ation being aware that upon f�ilure to dp sa,tho�taff hr�s no pltarnativa <br /> but to rejeCt it until it is c:omplete; <br /> • Soma or aA of the iniarmatfon tnaC y0u �re asked ta provide on tMia appliC�ltion is classified by State law as 8ith6r private or <br /> confidenii�l. Private data ia infarmalion which generauy r,an�at be glven ta the publlC but cen be given to the subjea of the <br /> data. Confidential data is intormat�on whfch generally cannoc bo giv0n to oirher the public or the subjoct af tho daCa. Our <br /> purpose �nd intended use of this lnformati0n is ba annually updaCe our rer.ords and records of other governmentml agenciee <br /> re ulred law. If yvu re e ta supply the inform0tion,the a Ilcation ma not ba issued. <br /> Applicant's Signature; , � Date: f��c�/ �� � <br /> 1,�8t Updefed= OS-Ut�-2011 <br />