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2010-01033 - roofing
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591 North Stream Road - 25-118-23-34-0004
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2010-01033 - roofing
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Last modified
8/22/2023 4:14:44 PM
Creation date
2/12/2018 3:48:50 PM
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x Address Old
House Number
591
Street Name
North Stream
Street Type
Road
Address
591 North Stream Road
Document Type
Permits/Inspections
PIN
2511823340004
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City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> Og,D,�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: <br /> Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> t`�kEsso4`� 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: <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 Aille <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: x5 LAX{BIZ l o/L S LLC. <br /> State License# 2a�/3`6b�2_ Expiration Date: ,2.9/i <br /> Phone: 612- 222 9-G(I (office) (cell) <br /> Mailing Address: C—IL city: sf ZIP: 5S 3 <br /> Contact Person: T;:-,?.- Applicant is: ontra r ! Homeowner (Circle One) <br /> Email and/or Fax: j,2z- Fb &k461z.r6C6u,_ <br /> PROPERTY OWNER INFORMATION: <br /> Name: .L lq /� -t,-' <br /> Phone (day): L( 7 <br /> Address: ��l�z City: ZIP: <br /> Email and/or Fax <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 /> Re-roof ❑ Fire Damage www.minnehahacreek g <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 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 /> required by law. If you refuse to supply the information,the application may not be issued. <br /> Applicant's Signature: 6 Date: <br /> Last Updated: 05-04-2009 <br />
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