Laserfiche WebLink
-70 <br /> J,6 <br /> g5l <br /> City, of Oron <br /> Building Permit Applicationor Internal Work <br /> (windows, doors, siding, r -roof, etc.) <br /> Ot o O�O mall fPO Box 66 ng Address. Permit number. -201,0- 407,F5 <br /> Crystal Bay,MN 5532370066 Date received: Vff/� <br /> a. Street Address: Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> Orono,MN 55356 <br /> Main: 952.249-4600 Fax: 952-249-4G16 www.ci:orono. us Total Fee: <br /> This application form must be completed In full and all req fired Information must be submitted. <br /> GENERAL INFORMATION: <br /> Incomplete appli ons will be return (please rint) <br /> Job Site Address; &::lea i <br /> Will this be a Parade of Homes, Remodelers Showcase Home or otheoisplay Home? ❑ YeY <br /> a No <br /> If yes,a epeplA/event permit is required with Ponce bspaftent and Chy Counw app 80 days prior to the evant. ShulHe bus service r►be <br /> r"ubed unless Applicant demonstrates suffldent on-site parwng!s aval/atle Non-permitted events will not be aftbumd. <br /> CONTRACTOR/APPUCA FORMA ON• , <br /> Name: I1�a�L ' <br /> State License# p Expiration Date: 2-0R1-g96jZ <br /> Phone: - office cell <br /> Mailing Address 3Q!R-.. v C ZIP: XS70,si <br /> Contact Person: Applicant is: ntractor Homeowner (circle one) <br /> Email and/or Fax: 1 m 1 of <br /> PROPERTY OWNERAF TION: <br /> Of <br /> Name: <br /> Phone(day): 3,-571 Gir <br /> Address: Ci r ZIP: <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ❑ Door(s) �]Rebel ❑Water Damage MCWD review&permits <br /> Minnehaha Creek Watershed District(MCWD) <br /> Wlndow(s) 'Repalr ❑Storm Damage 16202 Minnetonka Blvd <br /> ❑Siding [] Deephaven,MN 55391 <br /> Restoration <br /> ❑Other.(specify) Phone: 952-471-0590 <br /> ❑ Re-roof ❑ F1re Damage Fax: 952-471-0682 <br /> maw.minnehahacreek.oro <br /> Overall P ect Description: <br /> Estimated Construction Valuation of Praject excluding land) $ <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Drtment; <br /> Certifies that the Information supplfeq true and correct to the;best ofther knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete gpplication being aW"A 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'a p plication is classified by State law as either private or <br /> confidential. Private data is Infionnation 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 give i to either the public or the subject of the data. Our <br /> purpose and Intended use of this information Is to annually update ou records and records of other governmental agencies <br /> required by law. if you refuse to supply the information,the application n ay not be issued. <br /> w <br /> Applicant's Signature: Date: ,3L—3010 <br /> Last Updated: 05-042009 <br /> I 'd 1809 ' 0N ONM0 31 30 A110 Wd££:ti 010Z ' 1£' 9nV <br />