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Home My WebLink About2010-00393 - tent , CITY OF ORONO PERMIT NO.: 2010-00393 ` 2750 KELLEY PARKWAY ' ORONO,MN 55356- DATE ISSUED: 06/OU2010 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-TEMPORARY PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : TENT VALUATION : $ 0.00 NOTE: TENT USED FOR SALE AND STORAGE OF CONSUMER FIREWORKS APPLICANT pERMIT FEE SCHEDULE 25.00 FIREWORKS,FREEDOM,AND FUN STATE SURCHARGE(VALUATION) 0.50 3806 GABLES COURT EAU CLAIRE,WI 54701- TOTAL 25.50 (763)213-4499 OWNER Brook Investment Group LLC 34321 MYRTLE LA LJNION CITY,CA 94587- AGREEMENT AND SWORN STATEMENT The work for which this pertnit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied 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. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �i��Q�G� L K- l l � Applicant Permitee Signature Date Issued By ' nature SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . . City of Orono Building Permit Application Mailing Addr+ess: Pertnit number: �0/D -Gb 3 g 3 �'�� PO Box 66 � � Crystal Bay,MN 55323-0066 Date received: S �.? J d Street Addriess: Received by: � S � ti 2750 Kelley Parkway G~ Orono,MN 55356 Plan review fee: �� %� r��,�og� , -- Fax: 952-249�1616 www.ci.orono.mn.us Total Fee: 25 �a Main: 952-249-4600 This application form must be completed in full and all required informafion must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: Old Bowling Alley �423 Shoreline Dr., 55391 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes XX� No If yes,a special event pem►it is requiied with Police Department and City Council approva!60 days prior to the event. Shuttle bus se►vice will be requiied unless applicant demarstrates sufficient on-site parking is available. Non-pem►itted events will Rot be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Fireworks, Freedom&Fun State License# Expiration Date: Phone: 763-442-7676 (office) (cell) Mailing Address: 3806 Gables Court City: Eau Claire WI ZIP:54701 Contact Person: Quentin Nelson Applicant is: Contractor / Homeowner �c�r��or�e► Emait and/or Fa�c: Quentnelson(a�qmail.com PROPERTY OWNER INFORMATION: Name: �r Phone(day): (v - D �� l 6 I Address: �� Ci : � ZIP: Email and/or Fax PROJECT INFORMATION: Type of Projec� My earth movement may require ❑Door(s) ❑ Remodel MCWD review 8 permits ❑Water Damage Minnehaha Creek Watershed District(MCWD) ❑wndow(s) ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd Deephaven,MN 55391 ❑Siding ❑Restoration XD Other: (specify) Phone: 952�71-0590 tent Fax: 952-471-0682 ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq Overall Project Description: Estimated Construction Valuation of Project(excluding land) �.00 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • CeRifies that the information supplied is true and correct to the best of his/her knowledge. The applicarrt recognizes that they are solely responsible for submitting a complete application being aware that upo�failure to do so, the staff has no altemative but to reject it urrtil it is complete; � Some or all of the information that you are asked to provide on this application is Gassfied 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 annuafly update our records and records of other governmental agencies required by law. If you refuse to supply the i mation,the application may not be issued. �,,. Applicant's Signature: r-�%� ��--_ �- 25_� 0