2016-01190 - siding repair - Laserfiche WebLink

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s� � 1��/ O rC>!l0► Building Permit Application for Maintenance 1 Replacemenfi / Remodel — Residential ONLY ��.�� v��c��. r:��, �id��, ��..m.��§ ��. m ��.� ��`�� r..�.��:,�i� ��i��; ��` Mailing Address: Permit numbe . � ^ � ;/�-��T/� PO Box 66 /� f �/ Crystal Bay; Pv1N 55323-0066 Date received: "/—�- � � Received by: ' 4 � �� Streef Address: y ;�1 2750 Kelfey Parkway Plan review fee; `�l , ti� Orono, MN 55356 �"�fSti�� ` " 1 �� _w,__ Total Fee: Main: 952-249-46Q0 Fax: 952-249-4616 �vw�vv.ei.c�ronc�.mn.us This application farm must be compie#ed in full and all required information must be submitted. Incomplete applications will be returned. (Piease prrnt) GENERAL INFORMATION: Job Site Address: 100 Luce Line Ridge Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No !f yes,a specia!event pennrt is required wifh Polrce De/�artment and Crfy Councit approvat 60 d�ys prior fo the event. Shuttle bus seivics will be requrred unless applica��t demor�strates sufficient on-site parking rs avarlable. Non-permifteci evenfs will not be alloared. CONTRACTOR/APPLICANT INFOF2MAT10N: Name: Steven Craig Jansma Stat� License## BC 431870 Expiration Date: march 2018 Lead Certification Number: tvaT-��72ss-1 Expiration Date: octs,2a2� (for work an homes thaf were constructed priar to 1978 Phane: (cell) (office) Mailing Address: 14848 Kral Rd __ C�� tonka Z�P__.__��45_.�_.__ Contact Person: Craig.lansma � Applicant is: antract r / Nomeowner (Circls One} Email andlor Fax: � craigjCc�theiegacybuildin_qco.com PRUPERTY OWNER INFORMATION: • Name: Craig Passow Phone (day}: 952-472-6275 Address: 100 Luce Line Ridge ��tY�rono Z��'� Email and(or Fax: passow,�yahoo com remove and reinstall siding after installing house wrap on front PROJECT INFORMAT[ON; Overall project description: of house reoair rotten framinc� replace 2 windc�ws ______ _________......._.._.......______ _.___� _. Type nf Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage N1CWD review&permits: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(N1CWCli 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restaration ❑Water Damage Minnetonka, MtV 55345 ❑ Re-roof, other(specify) Q�Siding ❑ Uther: (specify} Phone: 952-471-0590 Fax; 952-471-0682 [�Window(s} wwv�r.minnehahacreek.orc� Estimated Construction Valuation of Project{excluding land) $ 5000.00 APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building I7epartment; �� • Certifies that the information suppfied is true and correct to the besk of nislher knowledge. The a�plicani recognizes that they are soleiy responsible for submitting a complete application being aware that upon failure to do sa, the staff�ias no altemative but to reject it until it is complete; • Some or all of the information thaf you are asked to provide on this applicatian is classified by State law as either private ar confidential. Private data is infarmation which generally cannot be given to ihe public but can be given to the subject af the data. Confidential data is inforrnatior� which generally cannot be given to either the pub[€c or the subject of the data. Qur purpose and intended use of this ir�form�tion is to an��ually update our records and records of other governmental agencies required by law. If au refuse tU sup�l the ir�fon�rakion, the applicakic�n may not k�e iss��aE:9, ApplicanYs Signature: _ — Date: �-25-2016 Owner's Signature: %��- � <' Date: J�� Last Updeted:,lanuary 2016