HomeMy WebLinkAbout2009-00307 - tent � '
> CITY OF ORONO PERMIT NO.: 2009-00307
•' 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE [ssuEn: 06/1 U2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3350 FOX ST
PIN : OS-117-23-44-0008
LEGAL DESC : FULLERTON ESTATES
: LOT 004 BLOCK 001
PERMIT TYPE : ACCESSORY STRUCTURE
PROPERTY TYPE : COMMERCIAL-BUSINESS
CONSTRUCTION TYPE : UNDEFINED
VALUATION : $ 0.00
NOTE: TENT PERMIT FOR CELEBRATION OF BRA"LIL BENEFIT GALA-3350 FOX STREET
APPLICANT: MN INTERNATIONAL CENTER-CONTACT PERSON-CAROL BYRNE 612-625-4421
APPLICANT MISC FEE 25.00
APRES INC
7625 CAH[LL ROAD STATE SURCHARGE(VALUATION) 0.50
EDINA, MN 55439- TOTAL 25.50
PAID WITH CC# 6139
OWNER
FULLERTON,MARNA
3350 FOX ST
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not gran[permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shal(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 oY 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.
�c �, ,��..e. � � , ,
Applicant Permitee ig ature Date Issued B ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHE THAN DESCRIBED A O E.
06-11-��9 �:33 PAGE2
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City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
...::-• •--• Mailing Addrsss: Permit number; �(. D �7
% .0 ��' �. PO Box 66
/O� �Q Crystal Bay, MN 55323-0066 Dats received: �P /� Q
IA8'
`'w'� Received by:
� � ZV ,.?;�, �1 Streef Address:
,�, . '• G / 2750 Kelley Parkway Plan review fee:
�i.���xa��.;� Orono, MN 55356
�_-`�" Total Fee: ����
Maln; 952-249-d600 Fax: 952•249-4616 www.ci.orono.rt�n,us,
This application form must be completed in�full and all required information must be submltted_
Incomplete applications will be returned. (Pleaso prir�t)
GENERAI. INFORMATION:
Job Site Address: _3 3.�U �v7� S� d L 1=� 5 S 3 S to
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
If yes,a speciAl event permit is requ��ec1 with Police Depertment arrd City Counc;�approval 6U days pnor to the evenr, Shuttle bus se►vic:�,wu!be
requiled unless App�iGant Aemunstr�tt�s�uHir.ienf on�r;ife p;�rkiny is evailavle. NUr)-po/rnlRcd cvcnts will not be Pllowel�.
CONTRACTOR I PPLICAN FORMATION:
Name: M INNE�v7'►4 —CN'rErW�fiGVY/��- �' ��f E� ,
State License# Expiration Date:
Phone: ��._ � 2 office � 71 � ` .� (cell)
Malling Address' C �� City: L ZIP' — ^
Contact Person: �n Appllcant is+�����ontracto / Homeowner {c��i.o�o►
Email and/or Fax: F1�
PROPER7Y OWNER INFORMATION:
Name: MhiLN� F�.ItLCI�-T'DI�, _
Phone(day): °9'S1 ' �/ �7 3 - S ?S7 � --�-- �-
Address� 1� '�" _ City��n�„ L�S� ZIP: S S 3S�
Email andlor Fax ���� T,��(,p,� �a� �j•��n� _
PROJECT INFORMATION; _
Type of ProJect: � Any earth movement may require
MCWD revlew 8 permlts
❑Door(s) ❑Remodel ❑Water Damage
Minnehaha Creek Watershed Dislrlcl(MCWD)
❑Window(s) I J Repalr ❑Storm Damage 18202 Minrtetonka Blvd
Deephaven, MN 55391
❑Slding ❑ Restoration [�Other:(specify) Phone: 952-471-0590
Fax: 952-471-0662
❑Re-roof ❑Fire Damage www;minnehaF�acreek„_,orA
r , --. ._ . --•--
Overall Project Description: '�'�a*C � � rz r v �- 3 Te✓i��� �0 x �L' J �O�(3�j�2_d
Estimated Construction Valuatlon of ProJect�excluding la d) $ �v � _
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information reyuired or requested�by the Bullding DepartmAnt;
. Certifies that the information supplied is Irue and correct to the best of his/her knowledge. The applicant recognizes that they
are solely responsible for submitting a complete application being aware Ihat upon failure to do so, the staff has no alternative
but to rejecl it until it is complete;
• Some or all of lhe information that you are asked to provide on this applicalion is classified by St�te law as either private or
confidenlial. Private data is Iniormatlon wliich generally cannot be givc�n to �he: public but can be given to the suDject of the
data. Confidential dala is information which generally r,annol be �iven to aithar the public or the subjecl of the data, OIIr
purpose and intended use of this inform�tion is lo annually update our rar.ords and records of other governmental agencles
rAc uired�law: If you refuse to supply the information,the application may rlol be issued.
Applicant's Signature: C�L-�. . � ...���.......-_---, Dale: �`�� /���_ �
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Last Updated. OS-04-2009 I�
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