2009-00452 - roofing - Laserfiche WebLink

Home Browse Search

07/30/2009 15:10 TEL 6512920905 TWINCITYROOFING I�001/001 . . City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) MailiPO Bo 66� Permit number. j�.��'�j � - ��t�� ,�o\ , +; 0 Q`', Crystal Bay, MN 55323-0066 Date received: ',�--; � ��'�� � 'a `�� .;� Street Address: Received by: ic'l�� ,) � ..:;. '`�� ;! ��`�;' 2750 Kelley Parkway ��gE��'`� Orono, MN 55356 Plan review fee: �--- .i�' �— . ; �� - Total Fee: ; �-(��f -� � Main: 952-249-4600 Fax: 952-249-4616 www.ci.ornna.mn.us This apptication form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: • - Job Site Address: Zz O �p� V� Will this be a Parade of Homes, Remodelers S case Home or other Display Home? ❑ Yes No If yes,a special event permif is required wrth Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be required un/ess applicant demonstrates sufficrent on-site parking is avaiJab/e. Non-permitted events will not be allowed. CONTRACTOR I APPLICA T NF�RMATIO • . Name: rtpp 'f5 • State License# Q Expiration Date: 1 0 Phone: b office cell Mailing Address: 7 Cit : ZIP: "j Contact Person: Applicant is: ontrac / Homeowner (Circle One► Email and/or Fax: y �, Q PROPERTY OWNER INFORMATION: Name: 0 �fYt 1 Of�1 Phone (day): �j p Address: 0 Cit : �j' ZIP: �j 3 Email and/or Fax PROJECT lNFORMATION: Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel MCWD review&permits ❑ Water Damage ❑Window s Minnehaha Creek Watershed District(MCWD) ( ) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd ❑ Siding ❑ Restoration Deephaven, MN 55391 ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 Re-roof ❑ Fire Damage www.minnehahacre�;k.orq Overall Project Description"j r Estimated Construction Valu tion of Project(excluding land) $ ��n APPLtCANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies re uired b law. If ou refuse to su I the inf mation,the a lication ma not be issued. i`. � ApplicanYs Signature: ' Date: �