Laserfiche WebLink
�� City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: 0���-Cd��d� <br /> �v�,� PO Box 66 <br /> � � � Crystal Bay, MN 55323-0066 Date received: /a�aZ1 /� <br /> ���`�'� Received b <br /> ,� t �,��_`� �, StreetAddress: y� <br /> �',F, '� �%� �titi 2750 Kelley Parkway Plan review fe � �2� <br /> �`�gESKo�'� 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 submi e . <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: , <br /> Job Site Address: � �xp�J ��'�� ��=y�=� I� �'�'�i�(� <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 is avaifable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: � <br /> Name: 1-._/y��Cf �7L%�v'✓ <br /> Phone (day): c�i�2- t�/Z- ����� �// <br /> Address: 1�(a� ��/ Cxi,�--, /.�r . City: (�,-G;;��> ZIP: G�5��� �-/ <br /> Email and/or Fax L�iv;� �� G:'v�c��r���c�� -f<<zr-�-, � <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review 8�permits <br /> ❑ Door(s) [�Ftemodel ❑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: �� /5� �-�,�2;L;,-y.-� �.., ��:��j �Y�v�f��,�� �,-j `�l-;c;�✓�i�r <br /> Estimated Construction Valuation of Project(excluding land) $ j �� - 2c���<� L� ��n-�.�_ <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 I the information,the a lication ma not be issued. <br /> ApplicanYs Signature: �����Gu�. cd �% Date: � ����3t�J/� � <br /> LastUpdated: 05-04-2009 <br />