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t � <br /> City af Orona <br /> �u��ding permit Applicatian for Maintenance / Renovation <br /> windows, doors, �iding, re-roo#, etc.) <br /> MaArngAddress: Per�nft.nurr�bsr: ,. ..'l�� . <br /> PO Box B6 �7.- o�fl -.. <br /> '�'��� c�ysstat Bay,MN 55323�66 Date�recei"'ad' . <br /> Q R�+celved by:> . <br /> ,� Sfreet Address: . � <br /> � � 2750 Kelley Parkway Plan review:fee: <br /> prono,MN 55356 p <br /> Taf�i Fee: 3��(� �� <br /> N�in: 952-249-4600 Fgx: 952-249-4616 .a rono. .us . . <br /> This appltcation forrn must be comple#ed in full and all requlred ic�fonnatton must be submitted. <br /> incompfefs apP�l��ns will be returned. (P/ease pr�nt) <br /> GENERAL INFORIM�►TION: r1 (� <br /> Job S�te Addres�: G� . Yes � <br /> • <br /> WIII this be a Parade of Homes,Remodefers Showcase Ham athsr D�isp�ro Bi6 event ShutBe bus seMc:e wr7!be <br /> t�yes e sP�����!s�4�d with PolFce Qepa►bnenf a►►d q!y CouAd1 sPProval <br /> requrr�d unfess s p p rica M d�►�n s tr e t e s s u�r c i�►�pn-sHe p a r k l n 9 is avapable. Non-Petml�ted e►rer�fs wNl not be aflowed <br /> CpNTRpC-r'qR/APPLiCANT INFORNrAT10N: <br /> N�1e: � \ � t��� Expiratlon Date� 'x✓ 3 <br /> State Livense# "$G1�O°1 �Pi�{ion Date' y <br /> Le�d Ce�tiflcation Numl�er - a a$3 - <br /> (f�or w�ohc on homes tl,ar wene ccnshvcasd.�vr�19r8 �offioe) (cell) <br /> Phone: (c51-� o� �40 ' ZIP_ S I <br /> Malling Address: l �• •• WeSk C+tY� ;1 � <br /> Contad Person: APPlicant is: ntra / Homeowner (G�on.> <br /> Ema��and/or Fax: <br /> PROPER7Y OWNER iN�ORMA'TION: � , <br /> Name: �u r► <br /> Phone(day): { . �6!�l' C�: ZIP: <br /> ��; LS� <br /> EmaiE and/or Fax <br /> PROJECT IN�ORN�ATION: Any earth movement may reqair�e <br /> �IPe��3� MCVIfb raview 8.peRnits: <br /> 0��g� ❑Remode{ ❑Flre Damag� Minnehsha Creek WB�ershed Dt�rfct(MCWD) <br /> R a�' D Storm Damage 18202 Minnetonica eh�d <br /> p Re-roof,asphslt � eP p�phaven,MN 55391 <br /> �R��f��r [,R�{pt�tion CJ Waber Darnage Phpne: 952�71-4590 <br /> o�r s FaX: 9sz-a71-ossx <br /> �Re-roaf,alher(specKlr) ���9 ❑ ( P��Y) �, 'nne ahacrea�� <br /> C]Wmdow(s) ` <br /> �_ d c�-� J� Y <br /> Overall P 'ect Descri on; GL � <br /> Es�n�ed Consbrucllon Valu� ProJect exaludl�g lan� � 3S <br /> APPLICANT AGKNOWLE�GEM�NT: �tcnent: <br /> . Agree��provlde all Informatlon ret�utred or requested by the Buliding Depa <br /> • C�tftes that the ir�forma6on supplled is true artd correct to the best of tiislher knowletlge. The applicant reca9t�es that they <br /> are salely r�ponslb�e for subrr►ildng a complete aPp�ic�uon�eing aware that up4n ia�ure to do so,the staff has r�0 altemaffve <br /> but to rejer�it uM11 It is oomplete: <br /> . $orrie or all ot the i�n that you are asked to Provlde a�this applir.ation is clessified by Sfete Isw� elthsr pN►�ate a <br /> cot�flderttial. Private data is infortnatbn whlc�generally cen�t be g'n►en to the Publb but can be glven to the subj�of the <br /> dsta. Confidentia4 data is infom�ation which general4y cettnot be glven to either th� public or the ��1 v�em�mentat a9enctes <br /> pu�and�te�nded refuse tp u�� i�ormatbnnthe�y u ti��uma ot�be lssued. ds c�oihe�'90 <br /> , � oa�: �f��� i�9 <br /> Apoiica�t s Si�netur+s: <br />