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Rpr �0 Q9 06: 1Op John volkmar 952-471-3155 p. l <br /> , � <br /> City of Orono <br /> Building Permit A plication <br /> �.O Meifins Addrass: Permit number. �Z D�'Od 26(p <br /> ,�, PO Box 68 ? <br /> � Q ... � <br /> Crystsl Bay,MN 55323-0066 Date received: <br /> ;�:. <br /> �,;,��.. ,► Received by: <br /> ! +�'� �` a Street Address: <br /> ��� '� �,�;,� �F 2750 Keliey Parkway Plan review fee: � <br /> �"_�; ,�o Orono,MN 55356 � <br /> -�`�sri-� Total Fae: 3` � <br /> �:_:-_-- <br /> M in: 952-249-4600 Fax: 952-249-4616 -- '. ...�--. � - � <br /> his applicatlon form must be compieted in full and all required information must be mitted.� �,�, `7 � , r��' <br /> incompletie applications will be returned. (Pleese print) __. <br /> GENERAL I FORMATION: , �� <br /> Job Site Ad ress: Zsao ke�ly Avenue,Exce�s�or,nnN s�� <br /> Will this be a Parade of Hornes•, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,s apec I evont pemiit is i9quN+ed wlbh PoUce DeParbn°�t arrd City Courrci!approv�!60 days prior to tl�s svent. ShufHo bens savlce wiN be <br /> irvd unless applicentdanortatref�es suflipentortsite paddng Ja avaiNble. Non-p�rmittod�wnts►n�iU notbe dlowad <br /> CONTRACTO 1 APPLICANT INFORMATION: <br /> Name: John Vdkmar <br /> State License Expirafion Date: <br /> Phone: (95 471-8744 (office) (612)508-2006 (Cell) <br /> Maiiing Addr s: 2640 K�I Av Ci : Excels�or 55331 <br /> Contact Pers : John or Sherrv Volkmar _ Applicant is: Contrector Homeovmer �a�aeo�� <br /> Email and/or ax: <br /> PROPERTY WNER INFORMATION: <br /> Name: see A►�ove <br /> Phone(dayj: <br /> Add�ess; • CitY ZI P: _ <br /> Email and/or ax <br /> PROJECT I FORMATION: Any earth movement may raqu�re <br /> Type af Proj : , MCWD review 8 pemills <br /> Q Door(s) �Remodel ❑Watier Damage <br /> Minnehaha Creek Watershed Distric�(MCWD) <br /> 0 Window�(s) ❑Repair ❑Sborm Damage 18202 Minnetionks Blvd <br /> Deephaven,MN 553�1 <br /> �Siding �Resbration �Otfier.(specify) Phone: 852-471-0590 <br /> Fax: 952-d71-0682 <br /> . ,. .._. .. . . . . <br /> [�Re-roof �Fire Damage _.__..._:-.--: :-......_...;..._... .. <br /> Overafl Pro Desc�i tion: Re lace basement windows Remodel downstairs bath Re lace front En door <br /> Estimated C struction Valuation of Pro ect excludin land 3 �8.0�•� <br /> APPLICAN ACKNOWLEDGEMENT: � <br /> . bo provide all ir�formatlon►equired or requesbed by t�e Building Departrnerrt; <br /> . Certifi s tl�at the i�rfoCmation suppfied is true and correct t�it►e best of hisJher knowledge. The applicant reoogMzes that they <br /> are lely responsible for submitting s complete aPP�ication being aware that upon failure to do so,the staif haa no altsmative <br /> but to ject it until it is compietB; <br /> • Sorrre or all of ihe information that you are asked t� provide on tl�is application is dassified by S�ate law as eitl�er private or <br /> confid rdial. Private da� is irEformation which generally cannot be g'iven�o the public but can be given to the subject of the <br /> data. Cor�fider�ial datg is information which generaliy cannot be given to e"dher the public or th subject of it�e daSa. Our <br /> purpo and inbsnded use of this information is to annually updatie our reoords'and records of ot�r govemmer�lal agenaes <br /> requ' d by law. If you retuse b�supply the infarmation,lhe application may not be iasued. <br /> .��� � (U'�/' Date: 04/30/09 <br /> ApplicanYs S gnature: . <br /> , <br /> ..� <br /> Re et Form � <br />