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� : . � s�s� <br /> City of Orono <br /> „ Building Permit A►pplication for intarnal Work <br /> windows, doors, sidi , ro-roof, rbc.) <br /> �0� ���' P�n,�ic nu�.r: 20 �/- 00 <br /> O O �en►,�ss�-ooee o.e.��: �5 <br /> � !, s�t Adar.�s: R.o.+ved by: <br /> dt�, 2760 KM�Y�Y Pl�n nsviativ fi�: <br /> Oiono.NNd 56366 <br /> Total FN: <br /> �; g��g�pp Fa�c �62 249�16 www.ci.orono.mn.us <br /> Ttds appNatlon 1bm�must b�oompl�d in fu1 and aN roqt�rod kM�rtnstlon must be submittsd. <br /> �P��PP�w�b�n�um�d. (PNese larint) <br /> �iENERAL NrFORMATION: � � �o� <��d c� _ �. <br /> Job Sib A�ddnss: v�o^'C <br /> Wal tl�ls b�a Parad�d HonNs,llrmod�Nrs sho�w�cw Nonw or oehK Dhplay l�onM? Y�s No <br /> Nrs,a�p�cf�!��nt p�m�ls Aquhd�Pb�D�D�pnlinrnt and QMy C�ovio/�►ro�l a0 das pbr to fh��rw Sfw�bus a�rvrc.wnM be <br /> �p�irrd ur�s�lbrk dMnoMl�a1M auQaNrk on�p�Adrp l�anM�bw. Mori�pMniNMd wwks w�not b�aMow�d• <br /> CONTRAiCTOR/ N�IFORMATION: <br /> Name: /11; r�Lb�"- 00 , S�� !�►hdot d Ln� <br /> stete I.�oense� OO�p a 7 7 ExvM'dtlon Date: p3/ / 62��a. <br /> Lead Certll�on Numbsr Expiretbn Date: <br /> �br w�ah on Aan�s tl�tw�r�o� b 1!'fe <br /> Pnone: 76 -H?7- 6 (�e) 76 - O- l 3 2 (��) <br /> Maiunp Addrsss: $' �`t' Ci�►: vG Z�P: 3 6 Y <br /> Co�c�Person: n� 4h APP�nt is: c�or / Homeovnner tc�a.a»� <br /> Email andlor Fax. ')�+3 -- �l p'�7� QOO <br /> ��ao�im owN��w�,►��y . <br /> lt <br /> Phone(day): � <br /> �: _ � Ng�_�c-� . S f��c.. �^'t �'���� ziP: <br /> - <br /> Email andlor Fax <br /> PROJECT INFORMATION: ������y�Wn <br /> T�°�P�� MCYYD nvNw i p�nNb: : <br /> � p p�`� p R«naiN O wa�•�� Npnnela�h.crwlc wa�rshse nisata(t�Acw�� i <br /> �W��s� �R� �g�p�pe 1820Q 1AinrnloNca BMd i <br /> ��� ❑ResloMion ❑Olhx:(spsd�Y) �•NN 55391 i <br /> Phor�: 962�T1-0590 j <br /> �Re�roof ❑Flro D�O� Fa�c 962-47�-0682 , <br /> e roo <br /> www.minnehahacreek.orn <br /> � <br /> �V�1 PrOJ�Ct O�fCfI�O�� <br /> Estimabd C�on�buctlon vaNweion oR P�+oj�at(�oocludMw� s f5�� _ <br /> APPUCANT A� : <br /> Ap�e�s m ao�rid�aN kwom�on nqii�d or nquwrd by 1M BuNdkq Ds� � <br /> ce�Hfss nm a�s a�tom+.uon«+avMb y au.and oorrsa to u�s best of r�i.n+er bw+Msdps• T►+e apa��V,et mey I <br /> aro so1MY nponNbl�for wbn�np�oo�p��PP�^bM�q���^hNuro ro do to.ths s�f tws no allsmarive ( <br /> but t�rejsct it tu�IN k is oanPlNs; I <br /> Soms or d d th�irrfo�mrtlon tlat y�ou an atlad oo qovld�on tlws appNcMion b daWMd bY 3bb Isw as eilher private or j <br /> aonlident�l. PrNar d� Is MOrr�alion wf11Ch pwfKaM!►pnnot bs�iven�o fhs pubNC but c�n bs piven t�ths subjec;t of the I <br /> dw. canAd�i da. is Intoma�lon whicn �+«M�►c.moc b. yiwn t� da�u,e pubNc or th. subj�cc or me dam. our � <br /> a��po�s and kpMd.d u..a w. inf«m.tlon r b«+n++y upd�es our rsooiw ana nconas or olh��o�+�nw eper►cies I <br /> Isw. If nit�t� th�k�/ornylion 1f� not b�hn�d. <br /> ,e,�s��,re: �'� �: 4��cg—tl <br /> �uvd.�.a: o�.o,,zo„ <br />