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Home My WebLink About2009-00295 - tent permit -, CITY OF ORONO PERMIT NO.: 2009-00295 • . 2750 KELLEY PARKWAY . ORONO, MN 55356- DATE ISSUED: 06/22/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 3423 SHORELINE DR PIN : 20-117-23-12-0034 LEGAL DESC : REG.LAND SURVEY NO. 1422 : LOT 000 BLOCK 000 PERMIT TYPE : ACCESSORY STRUCTURE PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : UNDEFINED ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 0.00 NOTE: TENT PERMIT FOR 3423 SHORELINE DRIVE APPLICANT MISC FEE 25.00 FIREWORKS,FREEDOM,AND FUN STATE SURCHARGE(VALUATION) 0.50 3806 GABLES COURT TOTAL 25.50 EAU CLAIRE,WI 54701- (763)213-4499 OWNER Brook Investrnent Group LLC BROOK INVESTMENT GROUP LLC 34321 MYRTLE LA IJNION CITY,CA 94587- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according[o the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and dces not gant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be wmpied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. applicant is r on 'ble for assuring all required inspections aze r s d in con e with the State Building Code.This permit may be r at any e f due cause. �6 �ZZ � � �o - licant Permi Signature Date Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. , . City of �rono . � Building Permit Application d.� .�..� ts� '�Q\1�,. Mailing Address: Permit number: �� ' '�V PO Box 66 Date received: � �� Crystal Bay, MN 55323-0066 f�. Street Address: Received by: a,� y �� ti�,/' 2750 Kelley Parkway \�`',� �oj/ Orono, MN 55356 Pfan review fee� `��kEsfl��'`-% \i �/ �� Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: , This applicatian form must be completed in full and aEl required infarmation must be submitted. Incomplete applications wilf be returned. (Please print) GENERAL INFORMATION: ,1ob Site Address: Old Bawlin Alle - 3423 Shoreline br., 55391 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No /f yes, a special event permit is required with Police Deparfinent and City Council approva160 days prior to the event. Shuttle bus service will be required unless appficant demonstrates su�cient on-site parking is available. Non-permitted events wi!l not be ellowed. CONTRACTOR/APPLICANT INFORMATION: Name: Fireworks, Freedom & Fun State License# 3 �p3b Expiration Date: ,�,,,(� 3�s' 2eo9' Phone: (office) (cell) 763-442-7676 Mailing Address: 3806 Gables Court City: Eau Claire WI ZIP:54701 Contact Person: Jordan Ruzicka Applicant is: ontr / Homeowner (Circle One) Email and/or Fax: jordanruzicka@hotmail.com PROPERTY OWNER ENFORMATION: Name: Sadia Punjani (Property Manager� Phone (day): 612-490-9161 Address: 34321 Myrtle Lane Union City City: CA ZIP: 94587 Email and/or Fax spunjani@aol.com PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review&permits ❑ Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWD) ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd Deephaven,MN 55391 ❑ Siding ❑ Restoration �her: (specify) Phone: 952-471-0590 ten� Fax: 952-471-0682 ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq Overall Praject Description: Estimated Construction Valuation of Project(excluding land) $0.00 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Oepartment; • Certifies that the inforrnation supplied is true and correct to the best of his/her knowledge. Ths applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject it until it is complete; `—� Some or all of the infonnation that you are asked to provide on this app[ication is classified by State law as either private or confidential. Private data is information which generalfy cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If yau refuse to supply the i rmation,the application may not be issued. ApplicanYs Signature: Date: � oa�f , . PER�II�� TQ APPR.�ACH MUNICIPA�:ITY �ireworks, Fr�edarn, 8c Fun 38+��:Gables Court Eau Cl�ire� WI 5�4701 7��.. 2-767� (cell} 7is-83s-6488`�fax) I give p�ermiss�on ;� � :��reser�tati�e of Fireworks, Fr++�eedom, &Fun to set up a tent in my parkinc; rc. �rt7m approxsmately� c7�� through 7 =�� ' ��_�__ for the p�rpose of se�ling retail flreworks. I undet�tar�d th�t ��r��c�rks, Freedom, & Fun witl comply witfi local c3rdirtianc�s and laws�nd will �p�>�o�i fc�r the necessary permitting, Firewc�rks, Freedc�3;�; :� �un will carry Iiability insuranc+� and a copy will be provhded to me arc� � ;�. iocal mur�icipality. SiC1C�l'��Y, .___��r1.1��.�._�__.��-`��n�1�N 1 Printed Mame __ _ ' ��..�._._��1�-&�h�,t�� - . � Name of Business �N 3 a 1 l`� �#� �� I�r� vn,'oN C��+�, GA , �s�1 �£�I"t'SS� �.1�lj �$r��_�"_, '_� ----�r- � a�`�,>�' - �P�r�,��N,'�ao�. �'e� Telepho�e E-mail ,� �,/ �., : ��(X L�� ,C _ .._--- �._.._.,_°.: ,. 5ignature o 'Busi�� . .��