2013-01194 - windows - Laserfiche WebLink

Home Browse Search

• r. 7'l City of Orono Building Permit Application for Maintenance ! Replacement 1 Renova#ion (No structural expansion. 4nly windows, doors, siding, re-roof, etc.} AT Mailing Address: Permit number: c�0 3'��l� �O�Y(7 Cry sal Bay,MN 55323-0066 Date recelved: l�—0—�3 Sfrest Address: Received by: '� ,C' 2750 Kelley Parkvvay Plan reviow fee: �� . y�' c? Orono,MN 55356 t`�k�sHn�`�' Total Fee: !�' �. �9 Main: 952-249-11600 Fax: 952-249-4616 www ci orono mn.us rf_g This application form must be completed in fu11 and all required information must be submitted. , Incompiete applications witl be returned. {Please prinf) GENERAL INFORMAATION: Job Site Address: _f�� (.��'� ��h e'�!�� Wlll this be a Parade of Homes,Remodelers Showcase Home o other Dispfay Home?�Yes No !f yes,a specia!evenf permit!s requlred with Pofice Departmant and C!ty Council appmva!60 days prior to the event. Shuttle bus ke wll!be requirecf unJess app!lcant demonstrates sufticient on-sfte parlJng is availabfe. fJon-perrnitted evonts wi11 not be allowed. CONTRACTOR/APPLlCANT 1NFORM TkON: Name: ��Q.ir' �IrO$ �.11+�r�P�(�- CO State License# Expiration Date: 31 � Lead Certification Number: -alp,�05-� Expitation Date: �. 6 (for work on homes that were constructed pdor to 1978 Phone: (cell} (office) �oZ-dZ%7-/r0� Mailing Address: 47.5 / � S,�v � City: Z�P� �53 4 3 Contact Person: A, � y� Applicant is: ontracto / Homeowner �circieon.) Email and/or Fax: (' {,y� �dy� ��/1�V�-+��JY10S . COV+ti PROPERTY OWNER INFORMATION: Name: �'jpVl�c:� �O �UM.a_l�► Phone(day): � - ��{y;Qy'Of�lO /UN ZIP: J�3J��'7 Address: �Cj ��,t C Q ^ l�1.� G�R G � Email and/or Fax: PROJECT INFORMATION: Overail ro'ect descri tion: ._.__ Type of ProJect: My earth movement may also requtre ( ) MCWD review 8 permits: ❑Door s �Remodel ❑Fire Damage Minnehaha Creek Watershed Disirict(MCWD) ❑Re-roof,aspfialt ❑Repair ❑Storm Damage 1g202 Minnetonka Btvd ❑Re-�oof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55391 ❑Re-roof,other(spectiy) ❑Siding ❑Other.(specify) Phone: 952-471-0590 Fax: 952-471-0682 Window(s) �'1NL�W's www�innehahacreek.orca Estimated Construction Valustion af ProJect(excluding land) $ APPLICANT ACKNOWLEDGEMENT: • Agrees to provide aN information required or requested by the Building Department; • Certifles that the informatioi�supp{ied is true and correct to the best of his/her knowledge. 7he applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is comptete; • Some ar all of the 9nformation that you are asked to provide on this application is Gass9fied 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. Confidenlial data is information which generally cannot be given fo either the public or the subject of the data. Our purpose and intended use of tnis information is to annually update our records and records of other govemmental agencies required by law. lf ou refuse to su I the'nformation,the a ficatiom m �ot be issued. Applicant's Signature: Date: �3 Owner's Signature: Dafe: Last Updated:03I06/2013