Laserfiche WebLink
YRy <br /> iR <br /> City of Orono �� <br /> � <br /> , Building Permit Application for Internal Work � <br /> i <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> �j,�,�. PO Box 66 <br /> 0 � Crystal Bay, MN 55323-0066 Date received: <br /> "`'�� Received b <br /> � � '�:,4;; �, I Street Address: Y� <br /> .�,� �� �`�� �ti 2750 Kelley Parkway Plan review fee: �� <br /> `�kEsxo�`'� Orono, MN 55356 ;� <br /> Total Fee: `�� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us " <br /> `,� <br /> This application form must be completed in full and all required information must be submitted. w� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ''��; <br /> Job Site Address: � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No ,� <br /> !f 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 demonstrafes sufficient on-site parking is available. Non-permitted events will not be allowed. .�� <br /> CONTRACTOR/APPLICANT INFORMATION: ,� <br /> Name: �7�� �= - �t�.�., zf <� <br /> State License# Expiration Date: � <br /> Phone: (office) (cell) � <br /> Mailing Address: City: ZIP: �� <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) � <br /> Email and/or Fax: <br /> :� <br /> ,� <br /> PROPERTY OWNER INFORMATION: � <br /> Name: ����1-�- � r�-.,�..��5 � <br /> „�: <br /> Phone (day): (�I� - 3�� ��50 '�� <br /> Address: "� � Col� ,N i,<<�. � Cit : - , ,� ZIP: ;�S����( ''� <br /> Email and/or Fax � 1���+} � i�,-� �-}--� �,�<„r���,L�,,,.` '� <br /> � <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 /> (�f Re-roof ❑ Fire Damage www.minnehahacreek.orq <br /> Overall Project Description: j� - �aaT o�.-�,� <br /> Estimated Construction Valuation of Project(excluding land) $ ,j��,v�j <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 /> Applicant's Signature: �i-'' � , � Date: I(� �- �`�C.� <br /> Last Updated: 05-04-2009 <br />