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City of Orono Building Permit Application for Maintenance / Replacement / Remodel , . . , ;yya-.. 'J'��1i1(;{C)W�, C�4��'�s"� StC�l�"IC�, t"£-�'U�:J3, `-�,'��:.. t�',ii. " `,7 : ?�'��.��f 3��'�r`��._ ��,`ti�z�a��e�✓1''+� Mailing Address: Permit number: ��,J� D ,� �� PO Box 66 � Crystal Bay, MN 55323-0066 Date received: �a7D'�.r Street Address: — c�ivedbv _ � y G� 2750 Kelley Parkway d. 7.�(k� pfan review fee: � �. �2 / `��q �� Orono, MN 55356 �.Y✓�J -�D�S_0�� K�s�i o _'To�'af�e�. �—� Main: 952-249�600 Fax: 952-249-4616 www.ci.orono.mn.us ,3 �, �� This application form must be completed in full and all required information must be sub itted. �J�� sq Incomplete applications wlll be returned. (Please prinf) � �� q��/S GENERAIINFORMATION: ``� �`� Job Site Address: 60 Myrtlewood Road, Orono, MN 55391 Will thls be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a special event permit is required wilh Police DepaRment nnd Cify Counci!approva!60 d3ys prior to the event. ShutUe bus service will be required un/ess applicant demonstrates sulficient on-sile parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: The Landschute Group, Inc. State License# BC002303 Expiration Date: 3-31-16 Lead Certification Number: NAT-27872-2 Expiration Date: 5-11-20 (for work on homes that were consirucied pr/or fo 7978 Phone: (cell) 612-532-1508 (office) 952-470-7416 Mailing Address: 202 Water Street #202 City: Excelsior ZIP: Contact Person: ]oe Paetrel Applicant is: Contracto / Homeowner �c�.��e o�� Email and/or Fax: joe@landschute.com PROPERTY OWNER INFORMATION: Name: Todd &Amy Hartman Phone (day): 612-518-2291 Address: 60 Myrtlewood Road City: Orono Z�p; 55391 Email and/or Fax: amylshartman@gmail.com PROJECT INFORMATION: Overall ro�ect descri tion: Type oi Project: Any ea�th movement may also requlre ❑ Door(s) � Remodel ❑ Fire Damage MCWD revlew& perm(ts: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 ❑ Re-roof,other(speclty) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project (exctuding land) S � APPLICANT 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 recogni2es 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 alt 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 required by law. If ou refuse to su I the info tio , he application may not be issued. ApplicanYs Signature: 'L Date: 8-17-15 Owner's Signature: v Date: a� ��' t� Last Updated:January 2015