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��C;�u/`%O1�iTi�F 1�. 30 AM Garloc[c-French F".X ".�c, Ll? 7?2 9754 p, ��`' <br /> _ � . <br /> c�ty o� oro�0 <br /> Building Permit Applica�ion for Maintenance ! Replacement 1 Remodel — Residential ONI.Y <br /> (i.e. windows, doors, sidi�ngy re�raof, etc. � NO 5TRUCTURAL EXPANSION) <br /> � Mailing Address: Permit number: G'� G'l J <br /> � �O PO Box 66 <br /> C ry s t a l B a y, NEN 55323-4066 Date reaeived: — �o ' � <br /> Strget Address: Received by, <br /> y �ti 2750 Kelley Parkway Plan review fee: <br /> `�r ��' Orono, MN 55356 <br /> "�K�sx�� � ! <br /> Total Fee: �G�� <br /> Main: 952-249-4800 Fax: 952-249-4616 www.ci.orono.mn.us J <br /> This applicatIon forrn must be compfeted in full and all required information must be submitted. <br /> Incomplete appllcatlons will be returned. {Please print) <br /> GENERAL,IN�C7RMATION: <br /> Job Site Address: �sss FoX st�eet,Orono,MN <br /> Will thls be a Parade of Homes, Remodelers Showcase Home or other Display Home? C]Yes ■ No <br /> !f yes, a specia!event p9�mlt IS requir�d with Police DeparCment 8nd City Council approVe160 dsyS prlor to the event. Shuttle bUs sBNICe will 6e <br /> Iequlrgd unless applrcanf demonSCrAtes SUffldent on-sife parKing ls ev&llable. Non-permitted events Wil!not be B11Pwed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Garlock-French RooPng <br /> State License# BC0014Z3 Expiration D2t�: 3/18/20 <br /> Lead Certification Number: r�ar-2ssss-z Expiration Date; ans�2o <br /> (for work on homes that were constructed prior fa 1978 <br /> phone: (c�ll) (office) <br /> Ma����g address: 2301 E. 25th St. city:Minneapolis z�P: <br /> Contact Person: n�e9 rvatnan Appiicant is: Contractor / Homeowner �c��cie one� <br /> EI1'1811 alld/OC FaX: mnaChan�garlock-french.com � <br /> PROPERTY OWNER INFORMATION: <br /> I�alTte: NIVI(V S MACMILLAN <br /> Phone(day): <br /> Addrass: 1685 Fox Street City:Orono zIP: <br /> Email and/or F'ax: <br /> PR�JECT INFORMATION: OVeI'all pf0�@Ct d25Cfiptiofl:Tearoff and replace cedar roof <br /> Type of Project: Any earEh movement may also require <br /> ❑ Door{s) ❑ Remodel ❑ Fire Damage MCWD review&permlEs: <br /> ❑ Re-roof,asphalt [� Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 15320 Minnetonka�Ivd <br /> ❑ Re-roof,cedar ❑ Restoration ❑Water Damage MinnetonKa,MN 553A5 <br /> �■ Re-roof,other(spealty) ❑ Siding ❑ Other: (specify} Phone: 952T471-0590 <br /> Fax: 952-471-0682 <br /> Gedar ❑Window(s) www.minnehahacreek.orq <br /> Estimated Constructlon Valuation of Project(excluding land) $5�,oi7 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to prQvide all information required or requested by the Building Departmant; <br /> • Certifies that the information supplied is true and correct ta the best of his/her knowledge. The applicant recognizes that they are <br /> soEely responsible for submitting a complete application being aware that upon failura to da so, the staff has no alternative but to <br /> reject it until it is campiete; <br /> • Some or all of the information that you are asked to provide on this application is cfassified 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 ta the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by iaw. If <br /> ou refuse to su I the inforrnation,the a lication ma not be issued, <br /> Applicant's Signature: Date: <br /> Owne�'5 SignatUre: Date: �y6/16 <br /> Last Updated�January 7016 <br />