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2017-00784 - stone repair
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1415 Park Drive - 07-117-23-42-0042
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2017-00784 - stone repair
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Last modified
8/22/2023 5:38:44 PM
Creation date
6/11/2018 1:09:50 PM
Metadata
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x Address Old
House Number
1415
Street Name
Park
Street Type
Drive
Address
1415 Park Dr
Document Type
Permits/Inspections
PIN
0711723420042
Supplemental fields
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� �� - � � RECEIVED <br /> City of Orono .`�' tu�� <br /> Building Permit Appiication for Maintenance i Replacement/ Remodel — Resider►fii�l`��L� <br /> (i.e. windows, doars, siding, re-roof, etc.—NO STRUCTURAL EXPANSiC1N} _ � pN0 <br /> q, Mailing Address: Pertnit number. <br /> �O�YO Crystai Bay,MN 55323-0066 Date received_ 7 '�7� 7 <br /> Received by: <br /> Street Address: <br /> y ` 2750 Kelley Parkway Plan review fee: <br /> Orono,MN 55356 h �� I� <br /> ��'�KEgHo��'G Total Fee: O� <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci orona.mn.us <br /> This application fonn must be completed in full and all�equired information must be submitted. <br /> Incomplete applications will be returned. (Piease print) <br /> GENERAL INFORMATION: t ,�� <br /> Job Site Address: <br /> Wili this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special event perrnit is required with Police Departmant and City Council approval 60 days prior to the event Shutfle bus se ice w/l!be <br /> required unless applicant demonshates sufficient on-site parking is available. Non-pemtitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: �� <br /> Name: � <br /> Stete License# '���"b� Expiration Date: � <br /> Lead Certification Number. �(�T'—�r�i��1 --� Expi�ation Date: ��_ <br /> (for work on homes that were constructed pnor to 1978 <br /> Phone: (cell) (offlce) 1 .� Q r <br /> Mailing Address: � C��' �" Z�P� S �� <br /> Contact Person: Applicant i ontractor omeov►mer �cireie one� <br /> Email and/or Fax: ' � - <br /> PROPERTY OWNER INF�RMATION: <br /> Name: � � t I�t� ���.N� �� <br /> Phone(day): . n,�,�, ��3. �I_ <br /> Address: �a�=� 4���y �'V�e. City: �S�[�tvD Z�F: (d�' <br /> _�..�—. <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Overall roject descri tion: � �� <br /> Type of Project: Any earth movement ay also require <br /> MGWD reviaw 8�permits: <br /> �p�o��s� ❑Remodei ❑Fire Damage Minnehaha Creek Watershed District(MCWD) <br /> ❑Re-roof,asphalt ❑Repair ❑Storm Damage 15320 Minnetonka Blvd <br /> ❑Re-roof,cedar ❑Restoration ❑Water Damage p�hone�n 52-471-05 05 <br /> ❑Re-roof,other(speciry) �5iding �Other:(specify) F�; g�2.471-0682 <br /> ❑Window(s) <br /> �' www minnehahacreek.ora <br /> Estimated Gonstruction Valuatlon of Project(excluding land) S <br /> APPLICANT AGKNOWLEDGEMENT: <br /> . Agrees to provide all information required or requested by the Building Department; <br /> . Certifies that the information suppiied is true and correct to the best of hislher knowledge. The applicant recognizes that they are <br /> sotely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to <br /> reject it until it is complete; <br /> • Some or ail 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 generaily cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is information which generaliy cannot be given to either the public or the subject of the data. Ou�purpose and <br /> intended use of this information is to annually up te our records and records of other govemmental agencies required by law, If <br /> ou refuse to su I the a 1icatio ma not be issued. <br /> ApplicanYs Signature: �'J Date: —��f � -- <br /> Owner's Signature: Date: <br /> Last Updated:January 2016 <br />
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