Laserfiche WebLink
� <br /> � . . <br /> • City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> �Q J1� PO Box 66 <br /> �`V Crystal Bay, MN 55323-0066 Date received: <br /> O�i{i;r��. � Received by: <br /> ��'"' Street Address: <br /> a ��;._ ,, <br /> � � �:,� . <br /> �,� ,Sti��` �ti 2750 Kelley Parkway Plan review fee: <br /> r9kEsxo4`'� Orono, MN 55356 <br /> _ Total Fee: <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. (P/ease print) <br /> GENERAL INFORMATION: �G V /►�0�,�� ��� ��,r�C <br /> Job Site Address: � � <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 approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Pella Windows &Doors ��� <br /> Phone: 15300 25th Ave N. Ste 100 S? 3y S •LOV�(cell) <br /> Mailing Address: plymouth, MN 55447 ZIP: <br /> Contact Person: lomeowner (Circle One) <br /> Email and/or Fax: Lic#20165884 Ph. 763/ 745-1400 <br /> PROPERTY OWNER INFORMATIONM• <br /> Name: D / '/Q � <br /> Phone(day): 6 0 M <br /> Address Cit : ���n ° ZIP: SS a L y <br /> Email and/or Fax Q$�� ?a� • y <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review&permits <br /> ❑ Door(s) ❑ Remodel ❑Water Damage <br /> Minnehaha Creek Watershed District(MCWD) <br /> �Window(s) �Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: /3 G.��/1Clu W /�� � U M I/� S <br /> Estimated Construction Valuation ofProject(excluding lan ) $ 3 3� 4 �r <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 <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to 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 the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to su t the informati n,the ap lication ma not be issued. <br /> �-� q� � � / 1 <br /> ApplicanYs Signature: y Date: <br /> ��. <br /> t <br /> Last Updated: OS-04-2009 <br />