Laserfiche WebLink
� <br /> • C i ty of O ro n o ���� <br /> � Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: DO �D 7 <br /> �0,�� PO Box 66 <br /> �� � ;,\ Crystal Bay, MN 55323-0066 Date received: <br /> >�. <br /> '���. 1� <br /> a ���L�. �,�� Streef Address: Received by: p <br /> �'� � �'�� �'�� �ti// 2750 Kelley Parkway Plan review fee: <br /> t�s �� '�� Orono, MN 55356 <br /> kESH�- <br /> Total Fee: C)Z -Jl'�1/ <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � J <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION:� �� <br /> Job Site Address: J % � C�Y���; <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill b <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitfed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Cit : -�lP� <br /> Contact Person: Applicant is: Contractor Homeowner ;(Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATIOIV� � <br /> Name: � '- �� <br /> Phone (day): �'�' � G' _ z ^ / <br /> Address: �"�; �� �/� Cit : ��/'' � ZIP: � � �'� � <br /> Email and/or Fax - � ` - � Z g , �',��, <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review &permits <br /> ❑ Door(s) ❑ Remodel I ❑ Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> �� �� � Fax: 952-471-0682 <br /> ❑ Re-roof ❑ Fire Damage - ��'� www.minnehahacreek.orq <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project(excluding land) $ �` �. �' � <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the informatio ou are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is informatio which gener cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information hich gen ally c nnot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this inf mation is ann ally update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to I the ' rma � ;the a lication ot be issued. <br /> � � _ <br /> Applicant's Signature: �'���' ��� � � Date: � �� � <br /> Last Uodate�: �5-04-2000 <br /> k <br />