2011-01451 - roofing - Laserfiche WebLink

Home Browse Search

��V-17-2011 11:01 From: 6785736615 To:9522494616 Pa9e:1�1 � City of Oron Building Permit Appiication for Mai tenance / Renovation windows, doors, siding, r -roof, etc.) Mailing Address: Permit number. G�D// �jj/ �/ 0 PO Box 66 O� �O Crystal eay,MN 55323-0066 Date received: ��" l� ' �� StreetAddress: Received by: � �,� 2750 Kelley Parkway Plan review fee: �� Orono,MN 55356 Total Fee: �.3C� O � Main: 952-249-4600 Fax: 952-249-�618 .ci.orono. n.us --t a, !9 d This application form must be completed in full and all requ ed infarmation must be s b�.ut'te . Incomplete applications will be�etum d. (P/ease print) GENERAL INFORMATION: �� Job Site Address: ��r Will this be a Parade af Homes, Remodelers Showcas�Home or oth r Display Home? Yes o If res,a special event permif is required wlfh Police Department and City CounCfl app 160 days prior to fhe evenL ShutHe bus ce will be required unless applicant demonsbates sul�iCien!on-site parking is availab . Non-permifted events wil/not be apowed. \ CONTRACTOR/APPLICANT INFORMATION� , � Name: � State License# .�. Expiration Date: � Z Lead Certification Number. Expiration Date: (for wvilc on bomes�at were conatructed privr to 1978 Phone: � , (office) (cell) MailingAddress: u� �, � City: ZIP: ��?,� - Cantact Person: ' ' Applicant is: Contractor / Homeowner �c�rore one) Email and/or Fax: ' �,,� � ��„�� ,.� _ �G1,V1 h@ s PROPERTY OWNER INFORMATION: Name: �� Phone(day); 9SZ-4!Z- ��R� Address: au2 w� � - C�tY� Ofov�� ZIP: 5' �'3�` Email and/or Fax PROJECT INFORMATION: Type of Project: ' Any earth moveme�may require ❑Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8 permits: Minnehaha Creek Watershed District(MCWD) ❑Re-roof,asphalt ❑Repair Q�oRn Damage 18202 Minnetonka Blvd L�Re-roof,cedar [�estaration ❑Water Damage Deepha,ven,MN 55391 Phone: 952-471-0590 �Re-roof,other(specify) ❑Siding ❑Othec (specity) Fax: 952-�77-0682 ❑Window(s) �.minnehahacreek.o►q Overall Pro'sct Descnption: c ��-Y� Estimated Construction Valuation of Pro"ect(excludi�g land) S 3$ 00� APPLICANT ACKNOWLEDGEMENT: . Agrees to provide stl infarmation required or requested by the Building D partment; • Certifies that the information supplied is tni�and cflrrect to the best of isJher knowledge. The applicar�t recognizes that they are soley responsible for submitting a wmplete application befng awa that upon failure to do so, the stafF has no altemative but to reject it until it is complete; • Some or all of the informstion that you are asked to provide on this a plication is dassifled by State law as eithe�private or confide�ial. Private data is i�fonnation which generally cannet be g' n to the public but can be given to the �ubject of the data. Confider�tial data is information which generally cannot be give to eithsr thg public ar the subject of the data. Our purpese and intended use of this infoRnation is to annually update ou records and records of other governmental agencies re uired b law. I# u refuse lo su I the informatien,the a lication nat be issued, : ,. ., ,. ., .. C1 /� .,_._. .�.� �,� l i �