Laserfiche WebLink
' °��lp� � �Z� ' �c0 <br /> City of Orono <br /> Building Permit Application for Maintenance / Replacement / Remodel <br /> (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) <br /> Mailin Address: `� <br /> �OND PO Box 66 Pe��t number. �or 5-c��� <br /> Crystal Bay, MN 55323-0066 Date received: <br /> �, � Street Address: �_:_� � ' <br /> G� 2750 Kelley Parkway Plan review fee: � S <br /> y`�t,� ��, Orono, MN 55356 � (�—�d�5 ,� <br /> kfSH� <br /> Total Fee: <br /> Main: 952-249-4600 Fa�c: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> JobSiteAddress: 1590 LONG LAKE SLVD nRONO MN 55356 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> lf yes,a special event pemrit is required with Police Department and City Counal epprova/60 days pnor to the event. Shutt/e bus servioe will be <br /> required uNess applicar►t damonstrates sufl�cierrt on�ite parking is availab/e. Non-peimifted e�rents will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �LEN FLAHERTY <br /> State l.icense# Expiration Date: <br /> Lead Cert�cation Number: Expiration Date: <br /> (for work on homes that were constructed p►�or to 1978 <br /> � Phone: (celq h 51 -2 31 -5 6 9 3 (office) h 1 �-�2 7-3�4 4 <br /> MailingAddress: 1590 LONG LAKF gLVD ��Y� �R��� Z�P�55�5F, <br /> Contact Person: ��E N F�a H E R T Y Applicant is: Contractor / Homeowner �ci�a o�.� <br /> Emailand/orFax: GLENJFLAHERTY�GMAII . cOM FAx F1 �-R�7-��51 <br /> PROPERTY OWNER INFORMATION: <br /> Name: GLEN FLAHERTY <br /> Phone(day): 6 S 1 -2 31 -S 6 9 3 <br /> Address: 1590 LONG LAKE BLVD City: ORONo Z�P:55356 <br /> Email and/or Fax: <br /> a5 ��►'� <br /> PROJECT INFORMATION: Overall ro�ect descri tion: R E P L A C I N G F R O N T S T A I R S ( ` ��� <br /> Type of Project: Any earth movemerrt may also requi <br /> , MCWD review 8 permits: <br /> ❑Door(s) �'i2emodel ❑Fire Damage <br /> ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 1R9n�MinnPtnnka Rlvd <br /> ❑ Re-roof,cedar ❑ Restoration ❑Water Damage �- <br /> ❑Re-roof,other s � ' \ /� <br /> ( PecltY) ❑Siding ❑Other: (sPeciry) C l� � �'�/� l, '����� <br /> ❑Window(s) � <br /> Estimated Construction Valuation of Project(excluding land) S_ ,�,/��� p ^�� ,��, <br /> /'" �L� L / �'�� i L°G� C''L��Gt �/�G% <br /> APPLICANT ACKNOWLEDGEMENT: �.1���`� � � <br /> • Agrees to provide all information required or requested by the Building De� �� y <br /> � � <br /> • Certifies that the information supplied is true and correct to the best of his / ; � � <br /> solely responsible for submitting a complete application being aware that / �L? ` �� � � ► <br /> rejed it until it is complete; �l�� C���Z ` <br /> • Some or all of the information that you are asked to provide on this aF �cc��, �,t.r�"�� Jc .��' c�r��;f%�� � <br /> con6dential. Private data is information which generally pnnot be given 1 r <br /> Confidential data is information which generally cannot be given to either � l t� I <br /> intended use of this info�mation is to annually update our records and rec� F <br /> ou refuse to su I the i formation,th lication ma not be issued. <br /> ApplicanYs Signature: D <br /> Owne�s Signature: ` Date: � � �� � `f..C�"�� <br /> Last Updated:January <br />