2016-01080 - deck attached - Laserfiche WebLink

Home Browse Search

City of Orono � Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows; doors, siding, re-roof, etc. — Nt3 STRUGTURAL EXPAt��} -' � Mailing Address: Permit number. �� l� —" �� � �-0��'�, PO Box 66 p Crystal Bay, MN 55323-006 Date received: -!— �p " �� Street Address: �$'�� Received by: ` �� I 2750 Kelley Parkw q Plan review fee: ��t�� `�'� C�rono, MN 55356 \ kP�t�v��.-' ��.J�i � � - Total Fee: Main: 952-249-4600 Fax: 952-249-4616 vvv�^J.ci.crono.mn.us ___ This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: � Job Site Address: ��0_,�. RRIh �Q . �fZOA1b 1/�� 536� Will this be a Parade of Homes, Remodelers Showcase ome or other isplay ome? ❑ Yes �'No /f yes,a special event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: � Name: State License # Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (office) Mailing Address: � City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Emaif and/or Fax: PROPERTY OWNER INFORMATION: Name: _ �L�_�� --- Phone (day): ,. Z/ Address: gp ,� �ie City: �,��,n/D ZIP: s�3,�� _ Email and/or Fax: �..�ah Q j��..t��p,�o�� __ PROJECT INFORMATION: Overall project description: Ce ]�K e�� DS� �+IKq � Type of Project: Any earth movement may also require ', ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: I Minnehaha Creek Watershed District(MCWDj �' , ❑ Re-roof,asphalt [�Repair ❑ Storm Damage I 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 i ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 � ❑Window(s) ��^r.lr,�✓_minnehanacreFk_:_oro Estimated Construction Valuation of Project(excluding land) $ d� 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 recognizes 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 I �, reject it until it is complete; ; � • Some or all 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. I Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and I, � intended use of this information is to annually update our records and records of other governmental agencies required by law. If ! � you refuse to supply_the information,the� Ip ication may not be issued. ___.j ---- — _ - — �lpplicant's Signature: �� /� -� Date: ��'�. �Jwner's Signature: ��u-.�� Date: 7� �� Last Updated:January 2016