Laserfiche WebLink
i. � <br /> Ci of Oro �a'"���'� �1�� <br /> �/ Ilo �a„r <br /> 6uilding Permit Appiication for Maintenance / Renovation <br /> (wi�dows, doors, sidin , re-roof, etc. <br /> A�aiangAd�ss: .�.�.•, . , ..:�. <br /> •:> .. . . . <br /> �ir�� PO Box 6@ Pennif�nii�b�::..;.:; :..�`';: ;:;,;,'.�T'/.�.• '•�',,. <br /> Q Crystal BaY�MN 553Z3-0066 .;'�;���. .:. : . :..........�;,�; •��.'�;,';� :�„�r.', <br /> O a.ce�feo�nreiic:� �;' <br /> e. Sbeet Addness: �Reoeh.l.ed:,� .. . �,. .. <br /> �' 2750 KeAey Parkway .Plan�r?evi.eW fee:;..`..: . . . <br /> Orono.MN 55366 . , �:���. ��:..:�...:.:.'�� <br /> •�TOtt�l Fe�• � ''.'��, �^ , <br /> Main �249-4600 Fex: 852-29�-4696 wuvw.cl.orono.mn. s � .. '��'`.,�`�';�`�','`"�!��',' <br /> ..;;•�`:�;:�.•::;:;.•�:.�'� <br /> ...�' :� •;..�..,:� ...'�'':�:•"� .• ,: �,�:;::'-'. <br /> Thi appli�n form must be comple6ed in fu11 snd ail requ�red ir�formetion must be submit�ad, � <br /> ed <br /> Incomple�e appllcativcis w111 be reRurned. (please priny <br /> G NERAI.INFO 7'ION; <br /> Job SiEe Add�s: sl � <br /> Will thls be a Paeade aF Horn��R�nodelers S owc�se Home or other Display Home? Yes No <br /> �!�',e s�edal ewr>tparm�7 is naqulred wi�,Pd"�ae Deparbnerrt end Gry Counpl epFrov�l BO a►�S R�or to fhe eu�, Shulds lws aervroe wlfl bs <br /> reqeaaf�Ced unfaas epplicartt demon.sbatps�an�a peddng fs au�eWa Non pannHEad ewrm�s wW not be sllo�d <br /> CONTRACTOR/APPLICANT 1NFORMATION: • <br /> NSt�te license# I ` -t�� ra. ' v� <br /> Fxpiration�ate: .. �_ <br /> Lesd Certificaation Number. E�cpirdtion Date: " <br /> (rar wwk on homes tfwt wwre Qo , prlor in 19Ys "' <br /> Pnone: 3•`i — 3 (o�fioa) ���� <br /> Mei�ing Address: oJc� ZIP: �( <br /> C�r�Ct Person: � � Applicant is: .r�trsctv / Homeowner l�e u� <br /> Emal and/or Fax: �, •�`. <br /> , <br /> PROPERTY OWNER lNFORYATION: i <br /> Nama: .� Y i • ¢, <br /> Phone(daY� �1— - $ <br /> ad� �, � c�►: C ce,(s►or ziP: <br /> EmaU and/or Fax <br /> PROJECT INFORIMATION: <br /> Type vf Pro]ect: My eaRh movement <br /> maqr nequlre <br /> CI 000r(9) O R�wdel ❑F'me o-dma9e Ncwo review&permt�: <br /> Minneheha Creek Watershad Oistrict(MCWD) <br /> �Re-roof,asphalt ❑Repeir ❑Slnrm Damage 18202 Miruretonlq Blvd <br /> �f,eeda� ❑Rsstor+�tlon ❑Water pamage Deephaven,MN .�►5391 <br /> Ph�e: 9�2-471-0590 <br /> R �othar spacuy) ❑Sid'mg ❑Other:(sP�pfy) F�c 952-471-0682 <br /> P.� [�2. ❑Vlfindaw(s) �!�w.minnehahacrQek.��g . <br /> Overall Project Deacri n:T ( ,4 <br /> Estimated Constructlon ValuaRion of pro ect(eoccluding lenc� S 1�3 00 p--' <br /> �APPLICANT ACKNOWLEDGEMENT: <br /> . Apraes t�provlde all trtfom�tion roqulred or�equ�sted by Ute Building deparhnen� <br /> • Cerdfiee that the inf�ormabon supplied is true and aortect to the best of hislher knowledge. 'fhe appUcant reoogn'izes tl�at ihey <br /> are solely responsible for submil�ny a compfebe application being awars that upon fellure to do so.tt+e staif has no alhernstive <br /> but to reject It untll it is uompletie; <br /> � Some or all af the infamation that you ere asked to provlde on tt�is applicadon Is dass�iBed by S�dte lew as eiTher privat9 or <br /> co�ideMial. Prlvate daha is informatlon which generally cannot be g"nren to the public but can be glven b the s�jed af the <br /> data. Co�idendal dals is miormaUon whioh geaerally c�not be given to eftlter the public or fbe suDJect of ihe dai�a. Ow <br /> Pu�se�nd fntended use of thi5 btformation is to armu�U�r update our reoords end r�emrds of oiher go�vemmenEsl agenaes <br /> irod law If refttse�to su the inf+am�tion 1lte 'a� not be Issued. <br /> �►PPficent`s Sig�atur,e: p�; � <br /> L99t Updefed: 08-09�D11 <br />