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� " � � �33'? -���- <br /> City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> ^�� Me�7ing Address: pgrmft number: o?D/f>� -6 <br /> �� �`O�\ Crystal Bay,MN 55323-0066 Oate reoeiv�: I/ b v <br /> 1� Sheet Address: Received hy: <br /> ��� , G� 2750 Kelley Parkwey Plan revlew fee: <br /> ���serao4`$ Orono,MN 55956 <br /> �~-�_ Totat Fee: ��'�• O�� <br /> Main: 952-249�600 Faz: 952-249-461B www.ci.orono.mn.us <br /> This applicatlon torm must be compfeted in full and all required information muat be submitted. <br /> Inoomplete applicstions will be retumed. (Please print) <br /> GENERAL INFORMATIO : � , <br /> Job Slte Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home r other Display Home? Yes No <br /> N yes,a specia/eve►d pemnY ia►�quhed►wY6 PoUee DePa►tment and City Councll epprova160 dfrys prlor ro fhe event. ShuNe bus servtce ll be <br /> raquired uNasa applicenf domot?stretes sufflcier►c on-s�Perkia9�s ava�aDM. Noro-pemrifted�vieMs wdl not ba aHo�+wd. <br /> CONT'RACTOR/AP LICANT INF RMA��N: <br /> Name: �� <br /> State Lkense# Expiration Date: <br /> Phone: ` °ffice ��� <br /> Mailing Address: C' : �J"I, ZIP: <br /> Contact Person: ApplkaM is: _ontractor Homeowner �cm�sone) <br /> Email andlor Fax: <br /> PROPER'TY OWNE IIdFORMATI N: <br /> Name: � <br /> Phcne(day): - C' :�r <br /> Address: ZIP: <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> ��p��: Any earth movement may requlre <br /> MCWD revlew&parmits <br /> ❑Door(s) ❑Remodel ❑Water Damage <br /> Minneheha Creek Watershed Disfid(MCWD) <br /> ❑Windaw(s) ❑Repair �Sto►m Damage 18202 Minnet�onka BNd <br /> Deepheven,MN 55391 <br /> (]Siding []R�sficration ❑OtAer.(speafy� Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �oof ❑Flre Damags www.minnehah creek,o� <br /> Oversil Pro ect Description: �- n0 <br /> Estlmated Construction Valuatio�of Project luding land) S <br /> APPLICANT 4CKN4WLED(3EMENT: <br /> . Agrees to provide sll Informalion requited or requested by lhe Building Department; <br /> . Certlfles l�at the infonnaden supplled Is true and oorr�ad to the besl of hls/her krw�nAedge• The applicant recognizes that they <br /> are solely respon8ible for submlldng a complete applicalian bsing awa►e thet upon fellure lo do so, Me stefF has no alt�emative <br /> but to reject it u�al it Is completa; <br /> . Some or all of the informetion that you ere asked to provide on Ihis applksNon is Gassified by State �aw as el�er p�iva�e or <br /> oonfidenhsl. P�Ivate data Is Infortnation whlch generally cannot be given lo the publlc but can be given to die subJed of the <br /> data. ConfideMiel dala Is informatton which generally can�ol be given to elther the public or Ihe subject oi the data. Our <br /> purpose end intended use o(lhis inbrmabo� is to snnually update our recoMs and reoords of olher grnremmenta� agendes <br /> re uired b law. If refuse to su q�e InMm�adon.lhe iceaon not be issued. <br /> A licant's Si nature: ' ��e� � � � <br /> PP 9 <br /> ��upda�ea: o5-aa-2oos <br /> � � <br />