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Ir . r City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, sidin , re-roof, etc.) ".:241) Mailing Address: V Pd Box 66 Crystal Bay, MN 55323-0066 • Street Address_ _ • 275 a KelleyParkwaY. Orono, MN 55356 . .::•..:>:::. :::.:::.. Main: 952-249-4600 Fax: 952-249-4616 www_ci.orono.m -us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 490 Old tons Lake Road.Orono,MN 55391 Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑Yes No If yes,a special event permtr is required with Police Department end City Council approval 60 days prior to the event Shuttle bus service Will be required unless eppfcent demonstrates sufrlclent on-sire parking is available. Nonpeumiarit evems wiTr no(be allowed CONTRACTOR/APPLICANT INFORMATION: Name: Think Stucco State Ucense# BC636389 Expiration Date: 3/31/16 Lead Certification Number: NAT-83420-1 Expiration Date: ioi2on5 (for work on homes that were constructed prior to 1978 Phone: (cell) 612-598-3571 ( ) 612-721-2011 Mailing Address: ��Al Por-1i4.4. Ac.S City:(rI n eof ZIP: Contact Person: Don Manc Applicant is: (i ont� Homeowner (Circle One) Email and/or Fax: info©think-atucco.com PROPERTY OWNER INFORMATION: Name: Barb and Larry Wiken Phone(thy): 952-476m26 Address: 490 Old Long Lakeiiji City:Orono ZIP; 55391 Email and/or Fax: bwiken©wiken.com PROJECT INFORMATION: Overall protectdescription: Type of Project: Any earth movement may also require ❑boor(s) 0 Remodel 0 Fire Damage !ACM review&permit; ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnebaha Creek Watershed District(MCWD) ❑Re-roof,cedar 0 Restoration18202 Minnetonka Blvd 0 Water Damage Deephaven, MN 5533911 0 Re-roof,other(specify) E Siding ❑Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 0 Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) • $1475a0o APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of hislher knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If __ you refuse to supply the information,the application may not be issued. Applicant's Signature: Lawrence Baker,Jr. - „':72:.•'.-- Date: 1013/14 Owner's Signature: _ Date: Last Updated:03/06/2013