Laserfiche WebLink
�' ^� C� ��'• �, S `� 5� <br /> City of Orono <br /> , Buikling Permit Appifcation for In�rnal Work <br /> windo�ws, doors, sk11 , ro-roo�f, �c.) <br /> ��� ���' wnnu nun�b.r: oZ0 Ll <br /> O O �e.r.�ss�x�-ooes o.�s�.oNwd: ! <br /> � � se►..c�d�r.�s: rt.os+v«►ey: <br /> 275o K.�.�►Park�r Pl�n nvi.w t..: <br /> Orono.1�N1 lf6966 <br /> Tohl F�e: /��p-� <br /> �; g�.�.�pp Fs�c 982 24�-/816 y�ww.c�.orono.mn.us <br /> This appNcatlo�lbem must b�oompl�Md in tuM and aN roq�nd UMorrtwtbn must bs submitDsd. <br /> M�oompNl�aPP�atlo�s wNl bt r+aWnNd. (P�fiss�Print) <br /> a��o�u►„o�: 3 � �;,,�1 Sf��c ��t <br /> .,ob s�.Add�ss: <br /> w�l this b.a Parad�ot F1onNs.Iamod�M�s sho�wr�Hon»or ou�.r o��pla�r Nom.? Y�s No <br /> M�,a�p�l�wnt prnr�lt�pii�d�Aob�OrpMrnmt and Qb C�ar�a/app►owl e0 d�pbr 10 M��rwit Sfw�l�bus sNvro�w�be <br /> �.y„r.d urM.a�pMa.rk drmo�Mrar.a�u�aM+w or�.p.raip a a�.aNs. Na,�p.+n�bd w.nts w!nor a a�aw�.a. <br /> CONTRACTOR I N�IFORMATION: <br /> Name: /J'1; �✓`S7- oo • S�� I..r3�dOFd LnG <br /> ststs uoense�t 2 oav�a �7 Exai�auon oate: �3�3� a��a, <br /> Lead ce�on Nwnber: ���s�: <br /> (Ibr w�aic on NoaMt tl�t o� b 1f7t <br /> �: 76 �a�- 6 c�� 76 — o— 13 � c�n <br /> �addrsss: S' c`I' C�r: v� ZIP: 3 6 q <br /> Contacx F►erson: /�r►�y n 4h APP�is: o c�or / F�omeowner �c�a.a»� <br /> Emau and�or Fax: 763 - SI a.7� 900 <br /> �anr owNat w�►no�• <br /> Name: _ T� ^'� �-�Ur h� . <br /> Phone(dsy): �¢'t� ZIP: <br /> addre�: _�a s 3s �a'�-�C �-'', �r �ty <br /> EmaN andlor Fax <br /> PROJECT INFORMATION: <br /> Ty��P� M�r wtn nwvrn�K m.y hquirr <br /> ❑poot�s) ❑R�ntodM ❑1NMK Darntps , MCWD�rNw�p�nNls: <br /> �Ahnefq�t�C�wlc Wa1NslMd District(MG'WD) ! <br /> ❑Wk�doM►(g) ❑R�p�ir ❑�� 18202�A�Na Blv� ; <br /> �s�a�n� D� O a�(�b) �wn,i� ssss� ; <br /> Pt�ons: 962�7t-0590 ! <br /> ��f ��p� Fa�c 952-471-0682 '� <br /> www.minnehahacreek.orn � <br /> Ov�ll Proj�ct DMc�iptlon� <br /> Estl�n�d co�o�vaw.uon a P�o�c.�a a� s ��d�a _ <br /> APPLICANT/4C � <br /> qpw,s w qovld�dl Nwam�lion nq�ird or nqu�d bY 1M BuNdk�D� � <br /> cehNiss n�c a,.M,romrbn«�ppMed is m,.and oorr�oc a a�s best ot hismer knowlsdoe• Ths appMau�t reoo�izes tl,et chey ! <br /> aro aoMly nrpornbl�ior wbn�k�p a oon�pMl��PPYaAb�+bN�+p���t�Po^hNuro m do so.1M staR ha no dosmaUv�s � <br /> but to rojsct it wMN k is oomplNs: � <br /> i <br /> 3ort»or all d 1M inlonn�tlon 1Mt you an adc�d to qovid� on this applk;aUon Is dssrllisd by Stat� law as N�privste or j <br /> oonifderq�l. Prlvals d� is frMOmfdion w11iCh pw�aMy C�nnOt bs�Nr�sn b ths public but Csn bs�iven�o tl�s aubjec�of the <br /> dsu. CoMidNMW dM� ii kMonn�tlo� which �N�eaNy C�nrwt b� �Irsn b eNtMt ths pubNc ot the subj�ct of the data. Our I <br /> v�rpo�s and i�d.a u..a a�i. �bne�tlon � m anw�N�►upd�s our isoo�d. ana nsoo�a. a o1��o�snta apencbs <br /> hw. If b 1tw NrbmyYOn N» not b�iNued. � <br /> ApplicaM's Si�na�ure: psts: _� -�6�r I <br /> �.tuvd.aa: os�ot�ot� <br />