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2012-00650 - roofing
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2012-00650 - roofing
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Last modified
8/22/2023 3:16:27 PM
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2/8/2018 1:08:53 PM
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Address
0820 North Shore Dr W
Document Type
Permits/Inspections
PIN
0711723220004
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City of Orono a <br /> Building Permit Application for Maintenance / RenovationGj <br /> (windows, doors, siding, re-roof, etc.) C. <br /> Mailing Address: Permit number: <br /> O�,© �O PO Box 66 <br /> ,r <br /> Crystal Bay, MN 55323-0066 Date received: <br /> 3 <br /> a s, Street Address: Received by: <br /> '� o~ 2750 Kelley Parkway Plan review fee: <br /> LgkZlslao *� 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: /, <br /> Job Site Address: bL6 juo e+(i IA•✓w, nr►v-<- <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 demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP ICANT INFORMATION: <br /> Name: 00( Gci rUa Cut e, <br /> State License# J9C 1.7 Zi S 3 Expiration Date: -A�3 i/ Z O/3 <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: _ 0 - O (office) (cell) <br /> Mailing Address: 5 S(, -5- 62oa,.7 4&C N, City: ZIP: <br /> Contact Person: � p�f Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: y 4 klle_� <br /> Phone(day): Cl�,2 — L��,t — 735-3— <br /> Address: <br /> 3S3— <br /> Address: �ZG IVB/ Q-+✓K ,c City: C/irovj"o ZIP: <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> �4e-roof, <br /> or(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: <br /> as halt Minnehaha Creek Watershed District(MCWD) <br /> p ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar VS <br /> storation ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> ❑ Re-roof, other(specify) ing ❑ Other: (specify) Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.orq <br /> Overall Project Description: <br /> Estimated Construction Valuation of Project (excluding land) $ <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 infor o hich generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is info at' w 'ch ge erally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of his Inform ioni to annually update our records and records of other governmental agencies <br /> required b law. If you refus to u I t e inf m o lication may not be issued. <br /> Applicant's Signature: L6 Date: <br /> Last Updated: 08-09-2011 <br />
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