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City of Orono <br /> �Building Permit Application for Maintenance / Renovation <br /> , (windows, doors, sidin , re-roof, etc. <br /> O � �/�" Renri�number. , � D� -Dd�7 <br /> O� ,�O po sox ss _ <br /> c�e�►.wnv s�oo� o�reo�ea: � -� <br /> sneeraaa�ss: <br /> R�ea e�r: . � . <br /> �� � 2750 Kelley Parkvvay Plan re�view <br /> Orono,MN�5356 � <br /> � Totel Fee: l 3�� O . <br /> Neir �9�,2�9�0 F�c 9�'t 2�+Ib'16 �::iy':a��::<:�.:;::::.".:;_?'..�_ . . <br /> This application fvrm must be completed in full and all required infom�ation must be submitted. <br /> Incomplebe applkatlon�will be retum�d. (Please pnnt� <br /> GENERAL INFORMATION: � <br /> Job Slba Address: � <br /> Will this be a Parada of Homes,Remodelers Sbo se Home or other Displsy Nome? Yvs 1+Io <br /> If yea,a s�aede�erent E►srmlt is��rred wrtn Pollce Ospar6nant and CJh+ccurwYl�pprovel 6o days w'�or b ohe�v�nt shutBe tx�ls a9►vroP w�R 6e <br /> required uNess appl�cant dem�onsdshes�o►hs�e PeAdr�fs avsil�e. Non�pennlltsd evrnl�w�not bs eAbwed. <br /> co�rncTott�nP�ic�rr iN�o�► : <br /> Name: <br /> Stat�Lioense# . Expiration Date: � — ��- <br /> Lead(�errtl�fcatiion Number: — � �- Expiratlon D�a�e: <br /> (for wwlc on hame�tl►�t ww�r conabucbd ' to 18T8�. D <br /> Phone: — (office) ^ � (��) <br /> Mailing Address: — ��� Z� <br /> Cantact Person: ApPlicant is: ntracto l Homeowner �r��a�.� <br /> �mail andlor Fax: <br /> pROPERTY OWNER 1 FORMATI N: � <br /> Name: <br /> Phone(daY): — — <br /> �d�: .. Cit�l ZIP: <br /> Email and/or Fax ���---_... � _ <br /> PROJEGT i�+1��ORMA'flON; <br /> .ry►Pe��J� Atry earth movement.mayl require <br /> ❑p��$) �Remvde� ❑F'x��ama9e MCWD�vie�•g pemtils: <br /> Minneheha Creek Waters�ed Dishid(MCI�IID) <br /> []Re-roof.s�sphalt ❑RePair 1����9� 182�02 M�netonka 81vd <br /> Deephaven,MN 5539t <br /> ❑R�roaf,cec�r �R�toration ❑Wabe�Damage Phoae: 952�71-059D <br /> ,�(Re-ro�tf�othsr(sPscitY) ❑Sidirt9 C�triher(spea� F�c: �52�471-Q682 . <br /> ,.n�. . ;,.�p.. ;:�q,t;:;'.:-.r:. <br /> ���($? ...---.,_�,,,,., ..__..._.. ._...,. <br /> Overa:!P 'ect Descripl�on: <br /> Ester�,atsd Corist�ction Vslnation af Pro eCt(excludin land S <br /> � � <br /> R►�P�.,ICAItT � <br /> . Aqrees to provide at1 information reguirsd or�uest�d by the 6uildirig aspattme�lt; � <br /> o Cert�es that!he ir�tocmatian supplied f�true arid c�to ihs best of hisTher knowiedge. The�ppUcant►ecagnizes th�at� <br />� �����sc�i�r�a c��tete ap�pdicalion t�k�g aw�re�et apoort taeiM�re to fb su,Ehe��ias r+c►a�x►�atiMe <br /> i��p nejeef'if��ie vompiete; <br /> + SaT.a ar aN� a�'f tha 6,�mation th�y���siced ta puai,�s en This appticati� ;s c�assifted by otato f�a �a ei-f,t�ei pti�a:s ar <br /> �r.fs�ntial. Pr+rais �� �s i�farmaSia� v:t+;ch gan�ra�{y c�.^.r�t be g�var to�sB a1:�`IIC �ii� L`�(1 r�8 '3IY8;! �J�E SE��eCi��� <br /> �2ta. COi�iQ�ilti8! �='�g IS t��t�.^,�tian �ich geneta!!y ean��t ba give� to either tF:e p�6lic �+!'ltte &uS;ecZ of J1e �. �UT <br /> purFoEs anQ �ntensied t!�a c�f khis info�rriatiQn is fi4 a�nually u��!e oeu?eo��ds and �cords of o#��e�av�Rnm+�4 e�+� <br /> 'r�Q , (f r�ft�se to s tt�e' 'ari.tt�a it�tQAn not be iss�di. <br />