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08I03l2017 10:46 Schmidt Roofing �A� P.002l002 <br /> , . <br /> C�t�l of Qrono <br /> Bui[ding Permit Applicafion for Malrttenance/Replacernent/Remadel—Resldendal ONLY <br /> (i.e.windows, doors, siding, re-roof, etc.—NO STRUGTURAL EXPAN310N), <br /> �O� MailrPO Boz 66� Permit numbe� d�7 ""� <br /> � Crystsl Bay,MN 55323-0088 Date received� "'� <br /> Street Addn�.ss: Received by: <br /> y� G` 27fi0 Kalley Parkway Plan�eview f�es: <br /> �R SHo�� Orono, MN 55356 <br /> Tota1 Fee_ <br /> Maln: 952-249�600 Fax: 952-248�616 ' ron .mn_us � • � <br /> This application form must be campleted in full and all requfred information must be submitted. <br /> Incomplete applications wiil be returned. (Please print) <br /> G�N�RAL(NFORMATION: <br /> Job Sfte Address: 2648 Lydiard Avenue <br /> Will this be a Parade of Homes,Remodelers Showcase Mome ar other Dlsplay Home? Yes No <br /> H yes,a speciel event pemtft is rnqulred►�ith Po1ke Depanment and Clty Councll approv�!60 dsys prbr to ft►e event. SI►utde bua aervlcs w�l be <br /> requned unless epplice�demo»sbete8 sulf�Clent on�9Re pRl'k!►tp 18 avallAbb. Norrpermltted everrts wdl not be sNowed. <br /> C�PfT'RAC'I"OR!APPLICANT INFORAAATION: � <br /> Name: <br /> State License# BC1778r�g E�iration Date: 3/31/2019 � <br /> Lead Certification Number. NAT 104279-2 Expiratfon Date: 7/20/2021 <br /> (fnr work on homes that were conatrucfed prlor to 1978 <br /> Phone: (ceA) (office) 952-$88-4889 <br /> Mailing Address: 3509 W Hwy�3,Bumsville MN 55337 �' . Z�P� <br /> Contact Pe�son: sandra Fleide Applicant is: Contractor Homeowner �c��c�s o�.� <br /> Email and/or Fax: sandra 6chmldtroofin .com <br /> PROAERTY OWNER INFORMATION: <br /> Name: Promfum Properly Group-Tara Steinbach <br /> Phone(dey): <br /> Address: 215 Walker Ave S Clty: Wayzata ZIP: 55391 <br /> Email and/Of FaX: Tara Steinbach�tara ste�nbach�yahoo.c�my <br /> PROJECT IN�ORMA7EON: Overall ro'ect descri tlon: <br /> rype uf ProJect: Any earth mavement may aleo requlre <br /> ❑Docr(s) ❑Remodel ❑Fire Damage ���Wew$parrnits: <br /> �Re-roof,asphait ❑Repair �Storm Dama�6 �Innehaha�Cr�O Minn�et na sllvd�(���� <br /> ❑Re-roof,cedar ❑Restoreti� ❑W�ter Damaga AAlnnetonke,MN 55345 <br /> ❑Re-roof,other(spoclty) ❑Sfding ❑Other.(specity) Phone: 9621t71-0590 <br /> Fax: 852�71-0682 <br /> ❑Window(s) www.minnehahacreek.oro <br /> Esttmat�d Constructlon Va(uatlon of Praject(excluding land) $�7600 <br /> APpLICAhE'f ACKNOWLEDGEMENT: <br /> . P�rees to provide all information required or requested by the Bullding Departmarrt; ' <br /> • Certiifies that the information aupplled Is true and correct to ths best of hisR�er knowtedge. '1'he applicant recognlzes that�ey are <br /> sol9ly responslble fior submltting a complete applicadon being aware that upon failure to do so, the staff has no altemative but to <br /> raject it until it is complete; <br /> • Some or all of the iniormation that you are asked to provlde on thla �ppllcatlon Is classifled by StabB law sa either prlvata or <br /> confldentl�l. Privete dete le Infonnation which genaralty cannot be given to the publk but c�n be glven to the subject of the data. <br /> Conftdential data is infomta�on Which generally cannot be glven to elther the p�lic or the subject of the data. Our purpose�nd <br /> ln�nded use of thls informatian is to annually update our records and reCofds Of other govemmentel agenaes roquirod by law. If <br /> - ou rofuse to sa the infcrmation tfie a 1ic,�bon ma not be issued. <br /> Applicant's Signature: c���Z��� Date: �3/20'I7 <br /> Owner's Slgnature: ���� <br /> Last Updated:January 2016 <br />