2016-00931 - windows - Laserfiche WebLink

Home Browse Search

AUG/� '2016/MON 10:34 AM Elder Jones Building FAX No, 952 854 4909 P, 002 � R� � City of Orono Building Permit Application for Maintenance 1 Replacemenfi/ Remodel — Residentiai ONLY (i.e. windows, doors, siding, re-roof, etc.— NQ STRUCTURAL EXPANSION) MailingAddrsss: Permit number: l��d �� PO Box 66 Crystal Bay,MN 55323-0066 Date received: � � � 5treet Address: Received by: L y� Gti�' 2750 Ke11ey Parkwsy Plan review fee: t Orono,MN 55356 "�K�sHo��` Total Fee: 3 5 p� . o�� Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 7his application form must be completed in full and all required information must be submitted. Incomplate appiicat�ons will be returned. (Please print) G�NERAL INFORMA710N: 5 g � NO r� [ Job Site Address: �� r��'M �ri Y c. Will this be a Parade of Homes, Remodefers Showcase Home or other Display Home? Yes No If yes,a specie!svent permh fs r6quired wlth Po!!ce Depa�fmBnt and Clry CounclJ approvel 60 days pdor to the event. Shuttle bus servlCe w!N be requfred unless epplicant demonstrates su�cient an�site parkirfg is available. Non permitted ever#s wi!!not be a!lowed. CONTRACTOR/APPLICANT INFORMAI"IbN: Name: State License# �e�la Northland Expiration Date: Lead Gertification Number: 15300 25th.A,ve N. Ste �00 �xpiration pate: (for work on homes that v �'lymoutlt,�V,('N 55447 Phone: (cell) �,ac#BC645090 P1x. 763/745�1400 �ce) Mailing Address: City: ZIP: Contact Person; n d� - ��r d n � � Applicant is: Contraotor� Homeawner �c►r�a on�� Emeil end/or F'ax: �•n �{i � � � ( � e p�� n � � _ C 0 M PR�PERTY OWNEF7 NFORMA710N: Name: �b u I n_ e h n s a n _ Phone(day): S+S� Y7 a - 'S/1 7 y� "� Address: � a 0 N o r��in LI!'['Y'L City: �0 �11 W ZIP: 'J's� b Y �mail and/or�ax; PROJECT INFORMATION: Overall project description: Type of Project: Any�arth mov�ment may also require ❑ Door(s} ❑Remodel ❑Fire Demage MCWD revisw 8 parmits: Minnehaha Creak Watershed District(MCWD) � Re-roof,asphalt �Repair Q Storm Damage 15320 Minnetvnka Blvd ❑Re-roof,cedar ❑Restoration (]Water Damage Minnetonks,MN 55345 � p �) � 9 � � p �� Phone: 952�71-0590 ❑Re-roof,other s eci Sidin Other: s eci Fax: 952-471-0682 ,F�1Nindow(s) www.minnehahecreek.ora Estimated Construction Valuation of Project(excluding land) $ APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all informatiorl�equired or requested by the Building Department; . Certlfles that the Irrformation supplled is true and correct to the best o1 hls/her know(edge. The applicant recognizes that they are solely responsible for submitting a complete appllca�on being aware that upon failure to do so,the staff has no altemative but to reject it until it is camplete; • Soms or all of the information that you are asked to provide on this application is classified by State law as either private ar confidential. Private data is information which generally cannot be given to the public but can ba given to the subject of the data. Confidential data is informafion which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this infnrmation is to annuapy update our records and records of other gavemmental agancies required by law. If ou retuse to su I the information,the a lication ma not be issued. ApplicanYs Signature: � Date: � ` � (l � Owner's Signature: bate: Last Updated:January 2�16