2015-01394 - finish condo unit - Laserfiche WebLink

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� �� .,�`j � ��, City of �rono . Building Per it Appiication for Maintenance / Renovation windows, doors, siding, re-roof, etc.) O�O� Malling Addrass: permlt number: �` a/ � PO Box 66 Q Crysta�Bay,MN b5323-0066 Date recelved: Q— � � i.�� SYreet Address: Recefved by: �� 2750 Keliey Parkway Plan revlew fee: �rc��o¢� Orono,MN 55356 Total Fee: � ��7 Main: 952-249-4600 FaX: 952-249-461& �vtv��,cl.orono.mn.us, / This applicatlon fo must be completed In full and all required infonnation must e s mitted. I complete applicatlons will be returned. (Please print) �.-f�( � . GENERA!INFpRMATIQN: Jo6 51te qddress: '2 v5 Will this be a Parade of Hames Remodelers Showcase Home or other D(splay Home? Yes �No If yes,a spaclal event pennM is requ d wlih Pofke Qepartmerrt end Clty Coundl epprove160 days pdor lo the event. ShuUle 6us aervke will ba required unless epp!/ce demonsfretes sulpctent on-site parkMg/s availeble. Non-permltted events will not be allowed. CONTRACTOR/APPLICANT I FORMATION: Name: �"�y�v{� �O►J S YLt�G�O� State License# L, y ( Expiration Data: Lead Cert'rfication Number. ��. Expiration Date: (for work on homes that were n f�ed p�lor to 9978 Phone: .�3�f (office) 5�. � _Z (cell) Mailing Address: Z..$v')L Zu o CnY: � �ZIP: Contact Person: Appiicant is: o ac ot / Homeowner �circie one} Email and/or Fax; ,��-- � �� t � PROPERTY OWNER INFORM ION: Name: inJ ip�(ip�r�Y�r�-N� '[�W I� Phone(day): -r$ _ �� Address: Sb0 -� City:�T.t,D� tuZIP: Email and/or Fax PROJECT INFORMATION: 7ype of Project: Any earth movement may require �Ooor(s) ❑R odel ❑Fire Damage MCWD review 8�permits: Minnehaha Creek Watershed District(MGWD) ❑Re-roaf,espha(t ❑R alr ❑Storm Damege 18202 Mtnnatonka BNd ❑Re-roof,eedar ❑R toration ❑Water Damage Deephaven,MN 55391 Phone: 952-47i-0590 ❑Re-roof,other(specify) ❑SI ing ❑Other:(specffy) Fax: 952-471-0682 ❑ dow(s) evw+N.minn ehahacreek.or4 Overall Project Descri tion: ��N "' Estimated Construction Valu ion af Project(exaluding land) $ ;. ��, �— APPLICANT ACKNOWLED EMENT: • Agrees to provide all tnfa tion required or requested by the Buildtng Department; . Certifies that the informafl SUpplied(5 tlUe ettd CorfeCt to the best of his/lier knowledge. The applicant recognizes that they are solely responsibte for bmitting a complete appllcalion being aware that upon fallure to do sa,the staft has no aiternaUve but to reject ft unUl ft Is co Iete; • Svme or ail of the(nform ion that you ere asked to provide on this appl[caUon Is classfied by State(aw as e(ther private or conftdentfal. Prlvata data s InfonnaUon which generally cannot ba g3ven to the public but can be given to the subJect of the ' data. ConfldenUai data I infotmation wh(ch generally cannot be given to either the public or the subject of ihe data. Our purpose and intended us of lhls intormation is to annually update our records and records of other govemmental agencies re ufred b law. If ou ref e to I th fo ati the a lication ma not be(ssued. i ApplicanYs Signature_ Date: _�/�/S' LflstUpdaled: 08-O8-2Qii �� �',