2016-01213 - remodel tuck under garage into office

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� City of Orono -8uilding Permit Application for Maintenance/Replacement/Remodet — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) Q Mailing Address: p�rrpit number. ��l�+►d�� g �O PO Box 66 Crystal Bay, MN 55323-006e6 Date received: MA�(,,j�� StreetAddress: R�CG'�e� Received by: � � O 2750 Kelley ParkwaY Plan review fee; �`�qk� o��,� � `� Orono, MN 55356 SEP � � 20t6 s H Total Fee: ��'r' � 5� Main: 952-249-4600 Fax: 952-249-4616 ' r This application form must be completed in fu I and all required information must be submitted. Incomplete applications will be retumed. (Please print) GENERAL INFORMATION: Job Site Address: �2 yp ('r�.-•!e r. Co�''�-f' /(/'v-f'c Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No ff yes,a special event permit is required with Police Department and City Council approval 60 days pr►or to the event. Shuttle bus service will be required uNess applicant demonstrates suf/icient on-site parking is available. Non-permitted evenis wifl not be allowed. CONTRACTOR/APPLICANT INFORAAATION: Name: ]� G C p�.c,f h� �f�o. State License# 1� C G S 3 � Y� Expiration Date: ,�-!d Lead Certification Number: �t/,¢ 7 _ F /S� G a?_, Expiration Date: � - �-2� (for work on hon�s that were construcfied prfor to 1978 Phone: (cell) 6( 2- 70� -�!�46 (office) MailingAddress: Y3d� S3'-r— S�• �Jw City: /�'1 /� L.,i4..c ZIP: ,J�r,�,T� Contact Person: �. �..�„/��. Applicant is: Contractor / Homeowner �c�rc�s or�e� Email and/or Fax: i�!��,f e�•17� G-r►-,;!. ('e•• PROPERTY OWNER INFORMATION: Name: ��;J �'-�r4 j f-e Phone(day): �p6 - qq9 - 2496 Address: !2 5l v G�►-d�� Co�-f �c.. -i� City: /1'l0✓„ d ZIP: S`.T�y Email and/or Fax: PROJECT INFORMATION: Overall ro"ect descri tion: R rrro o�� f uc� .�..P�- G-�.-� � i��o o�« Type of Project: Any earth movement may also require [s�Door(s) [�'Remodel (]Fire Damage MCWD review&permlts: ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Minnetonka, MN 55345 Phone: 952-471-0590 ❑Re-roof,other(specfry) ❑Siding ❑Other. (specify) Fax: 952-071-0682 �[]Window(s) www.minnehahacreek.orq Estimated Construction Valua#ion of Pro)ect(excluding land) $ 2600 � APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and coRect to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to rejed it until it is complete; • Some or all of the information that you are asked to provide on this application is Gassified by State law as either p�ivate or confidential. Private data is information which generally cannot be given to the public but can be given to the subjed of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and irrtended use of this information is to annually update our records and records of other govemmental agencies required by law. If ou refuse to su I 'nforrnation the a lication ma not be issued. ApplicanYs Signature: Date: � '�� -/< Owner's Signature: Date: Last Updated:January 2016 .�'�fX/ U�,r.� /�'/��4