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� - City of Orono <br /> . Building Permit Application for In�srnal Work <br /> win�Jo�ws, doors, sWi , ro-roo�f, e�cc.) <br /> .�,�,� �P�O e��' a.nnu nur,�b.r: oZ-d!l� O <br /> O O �Bn►.�s�ax�.00es o.���: � <br /> ,� � s'be.c Acbh.,a R°0°��' <br /> 2760 KM�Y�Y Plu�nviwv fi�: <br /> Orono.l�i SS366 <br /> ToW FM: I��•� <br /> �; g�.�4��pp Fs�c �52 24�i616 www.c�.orono.mn.us <br /> This appYatlon�orm must bs oompl�sd in tuM and aM roquirod k�ormatbn must be submit�sd. <br /> ��wIM b�r+NunNd. fPMsse P�nt) <br /> l3ENERAL INFORMATION: �fv,,,e <br /> Job Sla/1�ddrrss: <br /> Wal thls b�a Parad�of HonMs.11�mod�Ne+s Show�cw Hwn�or ol1�Displ�y Hoe»? Y�s No <br /> Mrs,.�c�id wwit p�m�k ir wq�ui�d�N�+bia�D�pnl�nt aad Gy Courw��pprvwl 00 dlas pbr e�pN�Nnt S►w�l�bua sMvro�w�w ce <br /> ►�q�Nrd unN�s�krrk�n�or�aMs at�alrrk on�prlalrp b arY�Al�. Nai�pNnMMd�wnts w!not b�albwrd. <br /> t�NTRAiCTOR/ N�IFORYATION: <br /> Neme: /J1; �✓LS�"- 00 , S�i I.A�O�.d Lir� <br /> State uoense#t 2 o ar o a �� Expkatlo�Dats: p3/3� bt��a. <br /> �c�e��no.r: ���: <br /> ry�o.w�o►rr on Aon�r awe a� a�m <br /> �: �b �ia�- � c�� 76 �o— 13 � c�u, <br /> Ma�irg Address: C`f- City: vL ZIP: 3 6 q <br /> Contact Person: n, 4h APP�is: c�o� / Homeow�er �cMa.a»► <br /> �,au�,a�a Fax: 763 - ti a�- 900 <br /> �im owN�w�owu�- <br /> Name: <br /> �,«�(day): � . <br /> q��: � City: ZIP: <br /> � �s'� - <br /> EmaN andlor Fax <br /> PROJECT INFORMATION: <br /> ��P�� M�►wth movwn�nt nay nquin ', <br /> ❑p�ig) ❑R�nadN ❑1Na�O�mps YC1ND nrirM�w i p�nNb: ' <br /> Miru,enr+.cnNc Wawsnsd oba�cc(Mcw�) I <br /> ❑W���g) ❑itep�ir ❑Stam O�rrnps 1820Q Mk�nebNca BMd ( <br /> ❑�p ❑R�lorstlon ❑Olt�x:(spsc+N) �D�^.Nw 55391 I <br /> Phons: 962-471-0590 ; <br /> ��f ��p� Fa�c 952-471-0882 i <br /> www.minn�hatrecreek.o�sa <br /> OV�II P�O�Ct OMC�O�� <br /> Estin�d caab+we�on Valu�lton ot Proj�at l�w� : f�a _ <br /> APPUCANT A�CKNOWLEDOEMENT: <br /> Aprws to porld�aN Momwlion nq��Nrd or nq��l�d b�►1M BuNdkp Dep�b�: <br /> CehNfN th�tlw kfbmn110n��PD�d is tr1N�11d OOrroCt b r1s bsst d hi�A�sr la�owledps• Ths�p�t roc�pn�zes tl�et they <br /> aro so1MY�po�abN for wbn�np�oa�P��PP���r��°^b�rs to do ao.ths sWf t�ss no d�smaUve I <br /> but m rsjsct U unQ R is complNs: <br /> 3ortis or aN d fM iMom�■lion tlat y�ou an a�d to provid� an this appMc�lion is d�sd bY Stab hw ss Mtl�prNste or I <br /> oonAd�nWl. P�iva�s d� is tdonn�ion wl�iCh pNlKa�y C�nnot bs�iven tic ths pt�bliC but Csn bs�n�o ths subje�t of the I <br /> dats. connd«Mw d�a it in�omwaon whicn ��«My►c.moc b. � m eitlwr n�e vubNc or uw �,bj�cc af ms data. our i <br /> P��P�� MMN1d�d uN d 1hY � i�b an�N�lly upd�s our r000nJ� and rsoords d ol�r�ovsmmsntal a9e�des � <br /> hw. M nA1N b Ih�iNOfnMYon 1h� not bs iNusd. <br /> ,e,ppAc�M's si�rwture: <br /> �: _-��`g' l� <br /> Last uva�d: 0.�o�,Zot 1 <br />