Laserfiche WebLink
From:LES JONES ROOFING 1 952 881 7009 09/19/2011 09:12 #239 P.002/002 <br /> . 1. <br /> City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding. re-roof, etc.) <br /> O MellinnOBox 68 Address:g Permit number. &40//-d/ 7?-� <br /> ` � Crystal Bay,MN 55323-0066 Date received: <br /> 7/y' i/ <br /> Received by: <br /> t'. Stivet Address: <br /> 2760 Kelley Parkway Plan review fee: 64%-/......- <br /> �.F,? Orono,MN 55356 <br /> Main: 952-249-4600 Fax 052-249-4616 www.ci.orono.mn.us Total Fee: L. �7 <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: O0 O/ 40 1,0,t 4: .1c o T,a. <br /> Will this be a Parade of Homes,Remodelers Showcase HdDie or other Display Home? 0 Yes <br /> If yes, <br /> a special <br /> us DCity Council epartment end <br /> 60 days prior othe Shuttle bus service will be�sspermit <br /> demonstratesois available. @tedvents event. <br /> allowed. <br /> CONTRACTOR �PLICA��INFO <br /> Name: :1-16)t-e. . �.. .--. <br /> State License# 6-(p Expiration Date: -3/'/Z <br /> Lead Certification Number 7j.q -7- - '%3 '7a - / Expiration Date: �- -R F- /5-- <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: ' /- a�+ff j/ (off ce) (cell) <br /> Mailing Address: ri . <br /> /� gov-+r- - City i04.'c�,�x ZIP: -- �aContact Person: / - - Applicant is: d -7U Homeowner (Guor.One) <br /> Email and/or 9, —, ,_ g8 t ./7,00 Gj <br /> PROPERTY OWNER INFORMATION <br /> Name: e� {71)--. <br /> Phone(day): <br /> Address: Sao t7/4 1-.4t..-k-.4.- )o CitY e �..r-7`ak_ ZIP: L s J ,/ <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ❑Door(s) 0 Remodel MCWD review& its: <br /> ❑Re-roof,asphalt ❑Fire Damage Minnehaha Creek Watershed D District(MCWD) <br /> pair 0 Storm Damage 18202 Minnetonka Blvd <br /> ❑Re-roof,cedar 0 Restoration 0 Water Damage Deephaven,MN 55391 <br /> roof,othersPhone:ax: 52471-0682952-471-0590 <br /> (specify) 0 Siding 0Other.(specify) Fax: 852-471-0682 <br /> F/ 0 Windows) www.minnehahacreek.orq <br /> Overall Project Description: 7 e.r 1 ref es b L 4 c- c1C "oe f- <br /> Estimated Construction Valuation of Protect(excluding land) $ /$,,3-leS v <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 - -nnually update our records and records of other governmental agencies <br /> required by law. If you refuse to the in r• ation the application may not be issued. <br /> Applicant's Signature: ' -' ! Date: 9- /9-/ / <br /> Last Updated: 08-09-2011 <br />