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<br /> City of Orono
<br /> 8uiiding Permit Appiication fo� Maintenance f Replaceme�nt/Remodel —Reaidential Ol+tLY
<br /> (i.�. windows, c400rs, siding, re-ranfi, �tc. -- �"�� STRUC7URAl. E�i�s+��:;tf3r`!;
<br /> __._.�_ 1
<br /> ,t', MaiJing Address: Permit number ��7'� �
<br /> PO 8ox 68 �/ �
<br /> �'�:�O;VQ'�' Crystal Bay,MN 55323-Ob66 / � daie received. ���_l----�
<br /> � Q l� ReCeived by: ��
<br /> �� Stret�t AAdre&s: ,p
<br /> �� 5 � 2750 Keikey Parkvray � 'b� Pian eeview tee
<br /> F V
<br /> \`��KESNe?��` CNo�o.MN 55�56 / /• / � ) j
<br /> Total Fee: f ( vl.� I
<br /> Main: 952-249�460� Fax_ 852-249-A6t6 Ww'N Gl,orono mn,us
<br /> � This appGcatian farm must be completed in fuil and aU required infatmaGon must be submftted.
<br /> Incomplete applications will be retumed• (Please print)
<br /> GENERAI INFtJRMATIQN: } �
<br /> Job Site Address: �c'�� `"��.�, .,,,a�� ^> c�\ '��.r�,�E� �lll��'..: �
<br /> Will this be a Rarade of Homes,Remodelers Showtase Nome or other Dlsplay Home? Yes No
<br /> !f yes.a spe�craf over�t pwrrur rs req�u�ea wim Pofice DeFartmerrr ar�e c�ry Coun�xl approval so days pna ro rhe ovenr. stumra tws sFxv�ce w�fr be
<br /> remnrncf unless appficarrf demvnstrates suK�crent on-srte p:ukrig+s aualabfe. lVort-permitted evenls w�not b9 a/bwed.
<br /> Ct)NTRACTOR/APPLIC4INT INFORMATIOM• (�
<br /> Name: r-.r.t�t�.���`� �`'4.� t����
<br /> State License# � Expiration Date: '�
<br /> lead Cartification Number. �;.�- � �� o c f�"-� Expiration Dat�: �
<br /> (for worlr on homea fhat wer�constructed prlor ta 1D78
<br /> Phone: (ceti} "" ;�,,.- ��.y�u-- � (office)
<br /> —�.______�—__ ���_ n�-- �ZIP:
<br /> Maiiing Address: _ p ��,� ;,� ` Gity: o $S '3 :�
<br /> Contact Person ���.�, �, __�/ __r�., APPlicant is� rrtractor f omeowner �circ�e ons}
<br /> _�_ - ��_
<br /> Emailand/orFax: __ �:,L.c����-`' 9;.��-c��s�a:� �Jk:� •T�-+�-�
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: �Cs r� �rn �'-Pl'5�,�
<br /> Phone(day}- �F'j;�- �F?,� � Qgr 5
<br /> P+ddress `�-a 7 Sf 5i�n ck�1c�,,�,� �.a� City: �.�t-f'�/u'� 21P:
<br /> Email andlpr Fax�
<br /> PROJECT INFORMATION: t�verall r 'ect descri tion: S� : n�� 5-�..ne ioc�-}�v.� ���;�-
<br /> rTYPe oi Praject: y rth movement may atso require ���
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