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City of Orono <br /> Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY <br /> (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) <br /> �O�O Mailing Address: Permit number. f - � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-Ib -I <br /> � � <br /> Street Address: Received by: <br /> yF �� 2750 Kelley Parkway Plan review fee� <br /> t � Orono, MN 55356 <br /> �'�B 5 H�� 1S� (,�� <br /> Total Fee: J <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 35 C stal Creek Rd Orono MN 55356 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bis service will be <br /> required unless applicant demonstrates sufficient orrsite parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> rvame: Steve Koehler <br /> State License# Expiration Date: <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes fhat were constructed prior to 1978 <br /> Phone: (cell) 612-280-4968 (office) <br /> Mailing Address: City: Orono ZIP: 55356 <br /> Contact Person: Applicant is: Contractor / omeowner (Circle One) <br /> Emaii andior Fax: skoehler(a�wck.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Steve Koehler <br /> Phone (day): 612-330-0483 <br /> Address: 35 Crystal Creek Rd city: Orono Z1P: 55356 <br /> Emaii andior Fax: skoehler@wck.com <br /> PROJECT �NFORM14T��N: OVef811 PfOJ2Ct d2SCflptlOn:Add/modify garage roof framing and sheetrock to raise garage ceiling for car lift <br /> Type of Project: Any earth movement may also require <br /> ❑ Door(s) �Remodel ❑ Fire Damage MCWD review 8�permits: <br /> ❑ Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 15320 Minnetonka Blvd <br /> ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 <br /> ❑ Re-roof,other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.orq <br /> Estimated Construction Valuation of Project(excluding land) $ ZSD • v� <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to <br /> reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of t he data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> ou refuse to su I the information, the a lication ma not be issued. <br /> ApplicanYs Signature: Date: RECEIVED <br /> Owner's Signature: �� �-- Date: � n <br /> . �� ,,,, � �. 2017 <br /> Last Updated:J ary 2016 <br /> cmr oF oRONo <br />