2012-00435 - roofing - Laserfiche WebLink

Home Browse Search

_ -'�-�;� �r; �_� s , xr � • City of Orono �'� � / � w,: L �. ' Building Permit Application for Maintenance / Renovation E� (windows, doors, siding, re-roof, etc.) � Mailing Address: � Permit number. �� g,�,�. PO Box 66 � Crystal Bay, MN 55323-0066 Date received: � r 0 � � �a , '�;'� �Received by: r� � a 9 �� , Street Address: �� � .:r 1,$, 6 �'�9r'.�'ro��- F / r \,�,t Gti 2750 Kelley Parkway Plan review fee: ��r R'kESHo'"� Orono, MN 55356 �: Total Fee: ' Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �� This application form must be completed in full and all required informafion must be submitted. '� > Incomplete applications will be returned. (Please print) �� �;. GENERAL INFORMATION: ��; �� Job Site Address: ,��'j ��U�Q � ��yj j�j� �� Will this be a Para� of�s, Remodef rs Sho�e Home or other Disptay Home? ❑ Yes ❑ No �� � /f yes, a special event permit is required with Police Department and City Counci!approva!60 days prior to the event. Shuttle bus service wiU be ��'�' T,�. required unless applicant demonstrates su�cient on-site parking is avai(able. Non-permitted events will not be allowed. ',� � '� CONTRACTOR/APPLICANT INFORMATION: r �� Name: G, � _ s,y -< ,� � 3,1� � � ; �� 'Y� State License# Expiration Date: � � Lead Certification umber: ��'� �y�,9�� Expiration Date: �'/��',� �: r� (for work on homes fhaf were constructed prior to 9978 �1�� �., ; Phone: -- � �� (office) (cell) ` s�' Mailing Address �� `�'";ri City;r ZIP: ''l"- -�� �� Contact Person: � ,� ��- � Appficant is: o ractor / Homeowner �c��ie o�e� � . 6 � — �� Email and/or Fax: � �; �� ,�= PROPERTY OWNER I F RMATION: � �; Name: „�/ '' � �� Phone(day): .' �'� • rv� "� Address: � ; � � / � � City• � ZIP: ,j � � Email and/or Fax '� -;� •:�{ PROJECT INFORMATION: � F Type of Project: Any earth movement may require �� �i��:, MCWD review&permits: � ❑ Door(s) ❑ Remodel ❑ Fire Damage ��, , , Minnehaha Creek Watershed District(MCWD) � �•: �Re-roof, asphalt ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd � N ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 �4f; Phone: 952-471-0590 �; ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 i www.minnehahacreek.orq � ❑Window(s) ,� , : �._ �� �� Overall Project Description: � � � S" v � �,.- Estimated Construction Valuation of Project (excfuding land) $ '� , fi� �" �� s." � �L' APPLICANT ACKNOWLEDGEMENT: �H f=- • 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 ° F ' are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative `'� � r but to reject it until it is complete; 5 �; �„i • 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. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our �'��. � purpose and intended use of this information is to annually update our records and records of other governmental agencies � ` � re uired b law. If ou refuse t su I the information, t _IicatjQti ma not be issued. `" ` . ' �9 ApplicanYs Signature: .�� G� � ��-� Date: �✓-�� 2-� w� � � Last Updated: 08-09-2011 ,�