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t �it of �rono Building Permit Application for Maintenance 1 Replacement C Remodel — Residential ONLY �.e. wi�� :aars, sic3�s�w� � � ��Xf� _ ��,� � C /�O A r Maiting Address: � d(�%7— � l PO Box 66 Permit number: VO Crystal Bay, MN 55323-0 6 t�� Date received: a-� !� � y � Streef Address: � ��tved by: � _� S. � 275�Kelley Parkway r�,,� P_��f review fee: i � �lq��.sH�� L Orono, MN 55356 �/ �<� ap� 7- �-p</3 �-' � � To a Main: 952-249-4600 Fax: 952-249-4616 .v_�n�.y.ci.orono.mn.us This applicatian form must be comple#ed in tull and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: � �/�/��'� Z��-� Job Site Address: 2408 Casco Paint Road, C}rono, MN Will this be a Parade of Homes, Remodelers Showcase Home or other Qisplay Home? ❑ Yes [�No /f yes,a special event pennrt fs required with Police DepaRmen#and Gity Councrl approva;60 days prior to the event. Shuitle bus service wi11 be requrred untess apptrcant demonstrates suffrcient on-site parking is availabte. Non-permrfted events wrll not be a11oU✓ed. CONTRACTOR/APPLICANT INFORMATION: Neme: The Legacy Building Co Inc State License# 431870 Expiration Date: 3/31/201$ �ead Certification Number: NAT 117268-2 Expiration Date: Oct 6:2421 (for work on homes that rvere constructed prior to 1978 Phone: (cell) (office) Mailing Address: 14848 Kral Rd C�t � � tonka Z��'� 55345 Contact Person: Craig,lansma Applicant is: antract r / Homeowner (Circle One) Emai1 and/or Fax: craigj@theiegacybuildingco.com PROPERTY OWNER INFORMATION: Name: James Gasch Phone (day): 612-834-1984 AddreSs: 2408 Casco Point Road, C�ty� Orono Z�P�55391 Email and/or Fax: jamesgasch@gmail.com PROJECT INFORMATION; Overall project description: remadel existing kitchen, replace 2 windows and 3 ext door Type of Project: Any earth movemenf may also require ❑ Door(s) (�Remodel ❑ Fire Damege MCWD review&permits: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Nlinnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phane: 952-471-0590 Fax: 952-471-0682 [�Window(s) �.r��v��.minn�haha�.�eek.��r.� Estimated Construction Valuation af Pro}ect(excluding land} $ 41,234.00 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide ell information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knawledge. The applicant recagnizes that they are solefy responsible for submitting a complete application being aware that upon fiailure to do so, the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide an this appiicatian 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 subject af the data. Canfidential data is informatiorn which generally cannot be given to ei#her the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. if ou refuse to sup I the inforrnation, the application ma not be issued. ApplicanYs Signature: /'-'/`�//"�/ Date: 2/712017 Owner's Signature: Date: Last Updated:January 2016