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01/07/2014 �7:40 19529555171 ALL PRO XTERIORS INC PAGE /0 . � City of Orono /- �^ �� Building ermit Application fQr Maintenance / Repiacement / Renovation (No ructural expansion, Only windows, doors, siding, re-raof, etc.) �� Mailing Address� Permit�umber: o�rj/ '"1-Y�J�/ PO Box 66 Crystal Bay, MN 55323-0066 Date received: /� �"/'S� St�eet Address: R��by: ��, 2750 Kelley Parkway Ptan review fee: G Orono,MN 55356 �CFsrto�� 7otal Fee, Mair1" 952-249-4d00 Fa�c: 952-249-4616 www.ci.orono.mn.us 2 �' Thi�application form must be completed in full and all required information must be submitt . � �L�✓ Incomplete applications will be retumed. (Please print) GEN�RAL INFO TION: �ob s�t�aad �b83 l�er�h. S�rt � � �tyza�� M�u 5�39 � Will this be a Pa de of Homes,Remodelers 5howcase Mome or other Display Home? �Yes No If ye�a specia!e �rtpeR7fit rs r�qui�d w�th PORr,9 DepanmerM antl Cfly Councll approval6o Uays prfor to tne evem. Shutt/e bus ServlCe wlll bQ iequir urtless applicant demonshates suAScient on-siCe parldrag is available. Non-permmed events will not,be allawed. CONTRACTOR/ , PPI.ICANT INFpRMATION: Name: � � ��o�S �C, State License# �, � Z$ Expiration Date: ��3�-J� Lead Certification umber: N AT -F ID�1 Kq�-� Expiration Date: �p_►$.�r7 (fpr wprk on ho ss that were constructed prior fo 1978 Phone: (ce�q b 12 - h w'7 _Z�n5 (office) 95Z •yab�'7�3 4 Mailing Address: «Zgt S�b'� v il? �ik ►og ��y� �+ �e b�ovr Z�P' S536`� Contact Person: ,,,,�, (�o��` Applicant is: on ractor / Homeowner �c��c�eone) Em�il and/or FaX: qk �� vo �Ierio� ��u� ,t�'1'r PROPERTY OWN R INFORMATION: Name: Re� e �+� Phone(day): Address: 3 bK 3 +�S S�►a+� �3� C��y� �raa a� ZIP: /4l�' Sa 3� l Email and/or Fax: PROJECT lNFO MATION: Overall pro ect description: Type of Project: Any earth movement may also r�quirs ❑Door(s) ❑Remodel ❑Fire Damage MCWD review B�permits: Minnehaha Creek Watershed District(MCWD) p Re-roof,asphalt � ❑Repair ❑Storm Damage �g202 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55381 Phone: 952�79-0590 ❑Re-roof,other(s � I[y� [�$i �ng �Other.(SpeCify) Fax: 952-471-0682 L�V�indow(s) www,minnehahacreek.ora Estimated Constru tion Valu�tion of Project(excluding land) $ 2 ,O�' APPLICANT ACK OWLEDGEMENT: • Agrees to provid, all informa�ion required or requested by the Building Department; . Certifies that the infnrmation supplied is true and corred to the best of hisTher knawledge. The apDficant recogniies that they are solely responsib i�or submitting a comple#e application being�ware that upon failure to do so, the staff has no altemative but to reject it until it is mplets; • Some or all of e information that you are asked to provide on this application is classified by State law as either p�ivate or cronfidential. Pri te data is information whieh generally cannot be given to.the public but can be given to the subjeck of the data, confiaentia�data�is information wnicn genera��y cannot be given to either the public or the subject af the data. Dur purpose and intended use of is information is to annually update aur records and records of other gavemmeMal agencies required by law. If ou re{use to su I the information,the a licatipm m �ot be issued, ApplicanYs Signature: G� Date: �� Owner's Signature: ^ Date: �"�`)y Last Updated:03106l2013 ' I